Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> I) IUuY\ .4— Sabra+ ..' ■Ac-4-Le c ("S 6Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 7(Q eik_5 /. 0.t j 3 , �// L,.,T� S--.,2 geed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS f Variance(# ) <br /> 0, 'r''ti z v (,i • - 3-05-a 64kAle 'A �._ 4../ :4,1141 I L 4 ate Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AGENT to Plan including location <br /> CONTRACTOR ADDRE'S f well/septic <br /> (City,State,Zip) (City,State,Zip) etb cks <br /> PHONE PHONE <br /> S. a Ian proval from <br /> lica le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loon plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ❑PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of prop <br /> PARCEL / " ^Q RSA i/ frontage dra o scale. <br /> NUMBER � �/Qf- /- <br /> TOWNSHIP: // SECTION: <br /> dOl /9 ys: kir %%4. /V/� 0 Drivew permit <br /> ADDRESS: / (state, ounty •wn) <br /> 7 / '? /�/ "'' l 0dyMir 5-36-60? Sanita •emiits <br /> CSM: ^� LOT SUBDIVISION' BLOCK/LOT <br /> Y (•ubli•, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ^ /A ,/ f` 6#444e ! g�J /{ ll }/�! 1, !onin District <br /> •QThis project is a new building or stru ure. 7 <br /> •ermitt-• —e? <br /> his project is an addition/alteration to an existing building or structur . <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ddres <br /> EWER EPTIC (new/-xistin• <br /> HEIGHT IN FEET: (\ i• NUMBER OF STORIES: (Not in luding basement) <br /> �Ty ❑ Wetland/F1 lain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland attaC ent) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: �I ❑ Erosio Cont permit <br /> -�' `'•al/ ST 4, TOTAL SQUARE FOOTAGE: j (slopes,di rbance, <br /> 2ND FLOOR: 3RD FLOOR: f �� cLE fiss) <br /> ESTIMATED CONSTRUCTION COST: ❑ R @Vle Location Survey\., 0 <br /> (Please round to nearest dollar) —00 --► • --II. —low —► $ 1 )C.,D and available options. <br /> r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ZA o on't know <br /> 2. Is there a wetland or floodplain on or near the property? LYes i!_ o on't know <br /> 3. Have you talked with the township about your project and are they in agreement? es II o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes 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) ❑Yes kV4 o DDon't know <br /> 7. Is this to correct a violation? l fres !i o <br /> f (..r-!-s) ? w APPLICATION MUST BE SIGNED <br /> 5.15-11., d (Continue on Back) -► •-■ -► <br />