Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C 4 STOMER TO PROVIDE <br /> OWNER NAME <br /> -Tenn■fer- t Rober-f- Russt..11 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) V Wing Status; CUP; <br /> Z---O MaI0n.ey Ci�/e- ai nce(#iction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ) <br /> 608-270 -0088 (8. 279- 8168 d eLa fnr����'h ay�•Con�I Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and i cludes dime ions <br /> AGENT NAME CONTRACTOR NAME <br /> 14'P tJ/A' ❑ S' PI ncluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS I/septic <br /> (City,State,Zip) (City,State,Zip) 1 Setbacks <br /> PHONE PHONE ❑ Site Plan pro from <br /> applic a to ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor p ns to s e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevatio f property <br /> ElPARENT NUMBER PARCEL ^ It ?OCURRENT�,ONI�JG: 1 ACREAGE: c. fronts dra o scale. <br /> PARCEL ((((,,�; '"Yt�X99� KK ff((���t <br /> TOWNSHIP: SECT 1 <br /> M ad i son 1/4: 1/41/4: W El Drive y permits <br /> ADDRESS: (stat ,coun , own) <br /> 2 )-0 Modone, Dr i Vc <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanit- permits <br /> (. • ic, private) <br /> PROPOSED PROJECT INFORMATION ,, AFF <br /> PROJECT DESCRIPTION: / / 3,4P' 't Back cL ck / x f..'' ,,! jag D <br /> . ®This project's a new building or structure. ,,f',,, , ',--` <br /> °y -4 ' <br /> (P�It; <br /> ❑This proje t is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI E: PERMIT NUMBER: © tt„c i !f§ ' <br /> SEWER nSEPTIC � 1 x € ( s <br /> yy <br /> HEIGHT IN FEET: NUMBER OF STpRIES: (Not including basement) <br /> Shot;. ., <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �rr <br /> C�I <br /> 4, TOTAL SQUARE FOOTAGE: 4, ,tt ` , <br /> � � ) <br /> 2ND FLOOR: 3RD FLOOR: / q 1 �,, 1 <br /> Q Review won Survey <br /> ESTIMATED CONSTRUCTION COST: $ (� ,� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ ' �J©� %„*Ot� u <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®fb(o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes E(No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes •No <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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ■No <br /> / CD APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) 1 <br />