Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to_Web.APP#' <br /> PROPERTY OWNER INFORMATION , • _ CU'.TOMER TO PROVIDE <br /> OWNER NAME4 <br /> at -e t- " E• (`e V my ning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> a (0 s--s- L.GC kg 062- L eed Restriction; CSM in a fiance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (0otr-YyN-015S vI I"evs'�1^M.a l e 41.10°°43Y ite Plan drawn toscale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA'TOR NAME <br /> I CO' CAD•=5.'• Site PI n including location <br /> AGENT ADDRESS CONTRA' 0'ADDRESS of w I/septic <br /> ' . ,7 Cmu s <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE Ste PI." approval fro -E" . <br /> (e 0 Qi 9 -cb 1 7 I ..." able township. <br /> E-MAILADDRESS E-MAIL••DRESS <br /> k loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/),_:; <br /> PARENT PARCEL NUMBER: CURREN sNING: ACREAGE: I Elevation of property <br /> ElPARCEL i( o7_'17 (_ 0 t�^ 0—a l`^ f 5-. © f frontage drawn Cale. <br /> NUMBER `P ]"j t <br /> TOWNSHIP: SECT!, <br /> / <br /> F 4/: N 0 Drivewa ermits <br /> Y I (state ount .w <br /> n)ADDRESS <br /> -- ,65 S (,c►-Lete- <br /> L - YVlO co-4 co-4 o► a (A)- - ,s---3S 7a. n S. ita•- permits <br /> CSM: O r LOT /. / SUBDIVIS ON BLOCK/LOT (• b"c,private) <br /> PROPOSED PROJECT INFORMATION STAFF REV EW <br /> PROJECT DESCRIPTION: �. s� e m u",. <br /> r � m.?a 7 <br /> sue, i1 .. 5f.�n ,6 ® uri:,� _ <br /> This project is a new building gr structure. i, I,_ mt sew <br /> This project is an additio alteration to an existing building or structu ; mo q <br /> SANITARY SERVICE: PERMIT N MBER: ,1 '`� `d° � 31 <br /> ■SEWER „SEPTIC ` } W .: <br /> HEIGHT IN FEET: NUMBER i"F STORIES: (Not including basement) 'sr ' �F <br /> (0 2'�etlan gp 2Dd g a <br /> `hore ari r clime VI- <br /> AREA TO NEAREST SQUARE FOOT: ;r ' * - . <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: T0S1(�rLCOA g g C'' <br /> f yo 1 TOTAL SQUARE FOOTAGE: ,, yjS�Q� •e 1.`,01S r' pan "t.n <br /> 2ND FLOOR: 3RD FLOOR: -- -C•4-9 <br /> ESTIMATED CONSTRUCTION COST: � - i- <br /> (Please round to nearest dollar) 3(p 0 , • - <br /> I <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? j Yes [I]No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? 10 Yes El No ❑Don't know <br /> 3. Have you talked with the township about your proje t and are they in agreement? ales ❑No " <br /> 4. Has there been a zoning permit issued for this pro erty in the past 5 years? LIYes ®No <br /> 5. Is this project associated with a rezone/CUP/varian e(petition/appeal# ) (leave blank one) <br /> 6. Is a location survey required? (see reverse) fYes o 0 Don't know <br /> 7. Is this to correct a violation? LIYes 0 No <br /> , --...%' 0 APPLICATION MUST BE SIGNED <br /> (Continue on Back) —+ =■ -9. <br /> 545-112(4/08) <br />