|
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME l (sicL QfpleidA C<,iie�' ❑ Zoning Status; CUP;
<br /> OWNER ADDRESS (Nu Street,City,State,Zip)J� t �-� Deed Restriction; CSM
<br /> �Jxf 144 it, Cgss V Gtir1S, v,J-a.� S� Variance(# )
<br /> HOME PHONE ! CELL PHONE E-MAIL ADDRESS
<br /> bos-?N9-05_• 6o 3M`)-I 00 ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME • OF CONTRACTOR NA
<br /> 1-, ; ' _0( A 1S60 0 6 s 1 1, LL., ❑ Site Plan including location
<br /> AGENT ADDRESS t)i'Ct fr a CONTRACTOR ADDRESS(1,4 ' of well/septic
<br /> (City,State,Zip) ls�c. (City, te,Zip,) �' ❑ Setbacks
<br /> 616��6c ti,, � 535IS IS1601< Lr�l., 'C35l
<br /> PHONE PHONE ! ❑ Site Plan approval from
<br /> 1Q�- -- ()S-4 `A' J- 'S-;X9 applicable township.
<br /> E-MAIL ADDRESS E-ip L•DDRESS
<br /> (• t CA' (w■ .,►! • O. I_ ;•,ik,4j 4 r .. _t`y ' .hi(1 e, G6a) ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us4 ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ElPARCEL /�/�p� frontage drawn to scale
<br /> NUMBER 0201' ---4Vl))-1 \ I �-,
<br /> TOWNSHIP: SECTION: k V• i e 1 �
<br /> 7 , 1/4: 1/41/4: ?riv,, . .;s
<br /> VJ�f� ❑ (sta - ;.: ''',.w (�
<br /> ADDRESS: , ) o(�
<br /> $ S�O K Wy J9 �,1Q)1)6,;-11), L_)�' Sanitary Permits �'
<br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanita
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION
<br /> R
<br /> v
<br /> PROJECT DESCRIPTION: 1)e . Grd sa-ten �Or
<br /> IA)I a 0 zont Dist ct
<br /> . ❑This project is a new building or structure.
<br /> Dithis project is an addition/alteration to an existing building or structure. , ,
<br /> SANITARY SERVICE: PERMIT NUMBER: © RuratAddress
<br /> SEWER I visegTic new/exiath;'
<br /> HEIGHT IN FEET: d NUMBER OF STORIES: (Not including basement)
<br /> aa iss . S Sla p
<br /> Shoreland (attachment)
<br /> AREA TO NEAREST SQUARE FOOT: %f
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , " , ,'�e
<br /> g , : t£� #
<br /> BASEMENT: aN 1ST FLOOR:
<br /> y TOTAL SQUARE FOOTAGE: ,IF (SiOpe,$.0ISt.irbanfe).
<br /> ftl ng/acces )
<br /> 2ND FLOOR: 3RD FLOOR: vt
<br /> 55g 'd
<br /> ff: � �� ,, ,
<br /> ESTIMATED CONSTRUCTION COST: $ �(1,�
<br /> (Please round to nearest dollar) ♦ ♦ "♦ ♦ '♦ ♦ "� ,. ,� f� S
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ©icrz- ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ID Yes ❑No 26-on't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes gift,-
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Qi Dle
<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 ❑NO El Don't know
<br /> 7. Is this to correct a violation? El Yes P10
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -•1 -► -+
<br /> 545-112(4/08)
<br />
|