Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> U{.J 4A/ V I40 L"'� *raid ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 303 ct S h4cly ,'dt{. 5-Iv i,4,1 it) ( S3)-e-ci Variance(# ) <br /> HOME PHONE / CELL PHONE I E-MAIL ADDRESS <br /> do) x'73-47'2.- 312_ 5-DZ- 77' S l,JK S)L 40 can [] ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5 ° /4 Li 4)/c- E Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ,3)3r Sk,.aceyFe4G <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> S-lob ►, W IFIP <br /> PHONE PHONE 0 Site Plan approval from <br /> 601( t13—S�I Z applicable township. <br /> E-MAIL AD RESS E-MAIL ADDRESS <br /> S (,-/IC 53,4 ∎i'yL. . CifYIP1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: evation of property <br /> ['N MBER vto11 --304 -` 023-3 iZ 3 i i I-r Sp-{t frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> p I�gsal 1 Sr! '^}, :� () 1/4: 5 e 1/'/.: S'�� [(Driveway permits <br /> ADDRESS: r' (state,county,town) <br /> 30 3S S L\L d1 5 c1k��r c 1 o 35 k lr <br /> ( "i S ; ) 1 Sanitary permits <br /> CSM: OT SUBDIVISION / BLOCK/LOT <br /> (public,private) N� <br /> .3 CL sent S .rr1) l�T . (P P ) <br /> PROPOSED PROJECT INFORMATION STAFF <br /> PROJECT DESCRIPTION: <br /> 4L(irM <br /> OThis project is a new building or structure. r ' . <br /> [l'fhis project is an addition/alteration to an existing building or structure. .` <br /> SANITARY SERVICE. PERMIT NUMBER: R. 0' i•a 4,'' <br /> EWER �EPTIC f - <br /> HEIGHT IN Fr, NUMBER OF STORIES: (Not including basement) 't{';'','Z, " <br /> 1 ','•-‘,.• • I <br /> k <br /> AREA TO NEAREST SQUARE FOOT: R", ' =, ' ` ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' r, tF ' 3 <br /> BASEMENT: 1ST O <br /> /0 ,' TOTAL SQUARE FOOTAGE: + t <br /> 2ND FLOOR: 3RD FLOOR: <br /> .„,,..,4, r <br /> ESTIMATED CONSTRUCTION COST: ¢ � <br /> (Please round to nearest dollar) $ / , //v 0 6 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes OVo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? 13S'es o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes , to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes 13\1 o <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) laes lap ['Don't know <br /> 7. Is this to correct a violation? []Yes ao <br /> �\ � <br /> ` APPLICATION MUST BE SIGNED <br /> U a <br /> 545-112(4/08) ^ J (Continue on Back) <br /> l ) <br />