Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME lee /I p <br /> cs& leek )4z/ ,,► Zoning Status; CUP; /`e� <br /> OWNER ADDRESS (NY‘ber,Str et,City, tat , ip) Deed Restriction; CSM <br /> 5-g G Li I'C o<- y � i)�� i2(1 Variance(# ) <br /> HOME PHONE CEIf(PHONE E-MAIL ADDRESS <br /> !j ^SS R 6 Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION Sand includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan in ludin o ' n <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septC 2l/ <br /> (City,State,Zip) (City, te,Zip) t cks `) <br /> PHONE PHONE e P pproval from <br /> applic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [fir plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dlane.wi.us/) vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACR G p p y <br /> PARCEL l frontage drawn to scale. <br /> NUMBER �SC�$�+�j q O 0) O �^ 1�°/� �� <br /> TgNSHIP: SECTION: <br /> 5 P. s1,e_la Q 1�4. f IAIA. Drive ermits P� <br /> ADD ESS: V (stat unty,town j? <br /> S ,Li .ec i d i'I)) P Sanitary permits <br /> CSM: LOT I DIVISION BLOCK/LOT (public ail <br /> PROPOSED PROJECT INFORMATION `VNiEw <br /> PROJECT DESCRIPTION: „ N 5 <� <br /> �e pt ece,y..„�o-F ex:S - Mob,/a 1.o,..c_)3 �C CG s t <br /> . EtThis project is a new building or structure. , Use? . <br /> This project is an addition/alteration to an existing building or structure. -"'; <br /> SANITARY SERVICE: PERMIT NUMBER: �� uralAddress <br /> 1-€14: <br /> nSEWER 1R�ISEPTIC �JQ�S ' a" � $ <br /> HEIGHT IN FEET: l V NUMBER OF STORIES: (Not including basement) �� % � <br /> Shur , attachment)TO NEAREST SQUARE FOOT: % <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Perm <br /> BASEMENT: 1ST FL OR: t• • • <br /> (� n ,, TOTAL SQUARE FOOTAGE: 4, eA, Bs1 ' '' r ace, <br /> lJ L J r4 <br /> 2ND FLOOR: 3RD FLO R: q O <br /> / a Ci Revs It ,._ V SuIYeY <br /> ESTIMATED CONSTRUCTION COST: �j , v, <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ )-(� - \r/5 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? E Yes ••s No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? E Yes r No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 17 Yes IN No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? gird es El 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 Nr,No Q Don't know <br /> 7. Is this to correct a violation? -s`► `• <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ <br /> 545-112(4/08) <br />