Laserfiche WebLink
SUPPLEMENT to Web•App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1,--CV) Ce A ,_\-enq 0,12i2n1 <br /> lN Zoning Status; CUP; <br /> OWNERADD5ESS (Number,Street,City,I StateZ Deed Restriction; CS <br /> M X(15 CO u 4 V0 WIS IA <br /> uul j 3") Variance(# ) <br /> HOME PHONE CELL PHONE a� E-MAIL ADDRESS f <br /> � �'�5�— di�� roct ros6' -?!(0 c h Ynco/ cool iv -Ste Plan drawn to scale ' <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension-' 4 e/ <br /> AGENT NAME CONTRACTOR NAME <br /> i = •-:•_ luding location A <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) RECEIVED . Setbacks 24/ u <br /> PHONE PHONE ,IZ Site Plan approval from <br /> OCT 2 6 2015 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> TO Floor plans to scale <br /> It <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.ce.ur.roe.wi.0 ,'} y+ Elevation of property <br /> PARENT PARCEL NUMBE CURRENT ONING: ACR E: , <br /> ❑ PARCEL ,9i/�Oil- P€ 'V- ,-- / . & 2 3 frontage drawn to scale <br /> NUMBER <br /> TOWNSHIP: C 0 <br /> • C.o 6/nom SE(J 1/: NE /a1/4: S ii Driveway ._ -.its <br /> ADDRESS: (state, oun own) <br /> e ''' C..- <br /> CSM: LOT SUBDIVISION BLOCK/LOT / Sanitary pe salts <br /> (public <br /> PROPOSED PROJECT INFORMATION 'STAFF REVI <br /> PROJECT DESCRIPTI• ':• biC 46 1 Nis TO(1 A l) l � Fr j mg 0 a ,-t <br /> ICC,tll- ' <br /> This project is r? ew builet or structure. ��� y � � <br /> This project is an addition/alteration to an existing building or structure. s4 ,- , , 1::,:',-,-;:„7::—:.,- <br /> ` <br /> SANITARY SERVICE: PERMIT NUMBER: ,� #; <br /> nSEWER SEPTIC dt . J s'' <br /> '# <br /> HEIGHT IN FEET: '8" NUMBER OF STORIES: (Not including basement) , <br /> @ ...• a a"' r <br /> hare. ri ' <br /> AREA TO NEAREST SQUARE FOOT: ; <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , �` , 4. <br /> BASEMENT: 1ST FLOOR: a aSF an . • <br /> 9 j TOTAL SQUA• •OTAGE: 4, D r . . u <br /> I • ' 4 # if <br /> 2ND FLOOR: 3RD FLOOR: t 0 : <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ' -.g„, ' - <br /> 1. The property is within 300 feet of a stream or 11:e feet from a pond or lake? . .. ill Yes r∎No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 6g'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 11 Yes 0 N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes `!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 ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes J <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />