Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME , n <br /> ra`-ro s f e ICC(.-4- (� K9� t4J2 Pr �9 ['Zoning Status;CUP; <br /> OWNER P 3R6s s1.N� r,Street,Ci ,State,zip) r Deed Restriction; CSM <br /> f3 U n/ � c/rk Lv l ` 3 S7 <br /> 2- Variance(# ) <br /> HO //P�ONE U CELL HONE E-MAIL ADDRESS <br /> 1D0� ( 37 S3J ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAMES rn CONTRA TOR NAME p _ <br /> 3-tin 111c-at Sc hctri1 6-rD yr In( ❑Site Plan including location <br /> AGENT ADDRESS (AA CONTRACTORADDRESS ) of well/septic <br /> /O/ON 6 05 j Ill (AAA i� ter (,J i <br /> (City,State,Zip) c3“ Q (City,State,Zip) (� ❑Seth <br /> Pa''� and PHONE ❑Si Pan proval from <br /> (pd 76)- 3 g0w' �0 d 7� ���� app wn hip. <br /> E-MAIL DRES E-MAIL ADDRESS <br /> /C o N h e milk - net ❑Floor tans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wLus/) ❑Elevation of property <br /> PARENT fPAA E NNNUUMBER: Q CURRE ZONING: ACREAGE: <br /> ❑NUMBER 0 ©v/ 15� �� uo I C- 2 S,0 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 16 7-.0niet- tIC /5— '/a: 5 (t/ '/a : S ❑Driveway permits <br /> / / ( ) 1 /� / /� (state,county,town) <br /> ADDRESS: 0 t V v S Fla) ' // 1 Q.7OY ll O.) C-C V <br /> CSM: I LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION " S TA'FF REVIiW' <br /> PROJECT DESCRIPTION: <br /> 1)C-\.e r ® Zoning Dlstnct <br /> This project is a new building"or structure. <br /> ❑ Permitted Uses <br /> IZIThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: O RuralAddress <br /> EWER NEPTIC (flew/existing) <br /> HEIGHT IN FEET: ✓ NUMBER OF STORIES: (Not including basement) <br /> ' ❑ Wetland/Floodplain/ <br /> Shorearid _(atta chunent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> '❑ ErosionControl per mit <br /> BASEMENT: 1ST FLOOR: a - <br /> I 3 <br /> 4, TOTAL SQUARE FOOTAGE + (slo pes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: - filling/access) <br /> ❑ ReviewLacafionSurvey. <br /> ESTIMATED CONSTRUCTION COST: /� andfavaila6le o bons <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ �/ b�/ ow p <br /> 1. The property is within 300 feet of a stream or 1000,feet from a pond or lake? ❑Yes 'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Q1'es o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes o <br /> 4. Has there been a zoning,permit issued for this property in the past 5 years? Wes Dlo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ffilo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(a/oa) (Continue on Back) ■ -► —► <br />