Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME , '_^ <br /> V2,i.ita a n 1-b es, 1--L� . Ei oning Status;CUP; <br /> OWNER ADDRESS mbar,�e°t,City,Sat C—.Zip) Deed Restriction;CSM <br /> 0 I Taw#J Q D - 1 i IClSI ^ jYl1 1_ .5 -1 I-3 Variance(# ) <br /> Hum PHONE CELL PHONE E-MAIL ADDRESS �,/ <br /> /,11 :.i�,0 I C D P GcL.rc,oc °L' V etz�, '. ,i• j• , . COWL E Site Plan drawn to scale <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION a Includes dimensions <br /> AGENT NAME _ CONTRACTOR NAME <br /> 5 k}'lle As tt bo V c, sit,��,:�, including location . <br /> AGENTADDRESS CONTRACTOR ADDRESS 0___ if,tic ` ` <br /> (City,Sate,zip) (Cay.State,zip) II Setbacks <br /> w Il <br /> �ut_•PHONE PHONE Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADORESS ,-,/ <br /> r1 r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) �I Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT INING: ACREAGE:S 670 X03 �fl8SCo d CTt '_ n.'1s S frontage drawn to scale. <br /> TOWNSHIP: oN , Y4'1/4: Driveway permits <br /> 1��� f C �4. (yte, county,town) <br /> ADDRESS: . <br /> S$ F cc.L Lcvu R.e_ l L a.n Sanitary permits ,�,. <br /> CSM: LOT �i > DMSIO11N, 1, BLOCKILOT (public,private) <br /> L , 1. ce I6NDo <br /> PROPOSED PROJECT INFORMATION r bT`a 4 ,:a i <br /> PROJECT DESCRIPTION: F^ - ^ , ' <br /> . Ecilibls project is a new building or structure. . <br /> D This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI PERMIT NUMBER: <br /> R SEPTIC 13-A0/5— oo 3 SCa <br /> HEIGHT IN FEET // NUMBER OF STORIES: at Including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT'. 1ST FLOOR: I'i<: + ti <br /> / �]/ 7-. + TOTAL SQUARE FOOTAGE: j '„ . <br /> 2ND FLOOR: /, ! 3RD FLOOR: (A33 <br /> ESTIMATED CONSTRUCTION COST: 00 a <br /> (Please round to nearest dollar) "♦ "� —01. —I• "� "� 5o , U ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes 1i 0 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes' No 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? tees 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes aKo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leap blank If none) <br /> 6. Is a location survey required? (see reverse) IMes ON ❑Don't know <br /> 7. is this to correct a violation? D Yes Mo <br /> l o ` APPLICATION MUST BE SIGNED <br /> s n 5:2-1. U (Continue on Back) - —1► —0-546-112 I <br />