Laserfiche WebLink
(0h Pt <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME \ <br /> L42aw C—' Dc.A.e_ , LL( (3'0L.. N erect 1 , ccC 1 A Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / Deed Restriction; CSM <br /> (3Z IE CuLO.CELL Vo.ItEy /7.1,E / A SS 535Z9 it Variance(# ) <br /> HOME 1 55"09CC - ,s -_ - to-a I .- gj Site Plan drawn to scale <br /> AGENT INFORMATION ( CONTRACTOR INFORMATION and includes dimensions <br /> AG .T NAME CONTRACTOR NAME • <br /> ,,,_x. p. SL.eA t.►K 0.,,,d Ccs-v 3u, LL y"K ®Site Plan including location <br /> A ENT All vratSS CONTRACTOR ADDRESS / of well/septic <br /> 101 S. ifIck, SiTeei, St,;4e C (el E Ille,- t St. 43 <br /> (City, ) (City.State, <br /> S ` 'Setbacks <br /> �nRa ;d6t rat D Z-7.- rtct LJ_T 5559 <br /> PH E 0 Site Plan <br /> , royal from <br /> om <br /> bit R2 — S 2 s 1 "` AL- U 50 — 1i 3 app j township. <br /> E-MAIL•b I RESS <br /> e l - eS —474A iK d t - . 41 - T , ,'j ®Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ®Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: 'ACREAGE: <br /> 0 -ZI <br /> NUPARCMBEL • •..1 frontage drawn to scale. <br /> ER .j, Z�Q�`O •%ix •t���bl o. 0 <br /> TOWN.S CTION: 1 / 1 W/ <br /> envy a 31 '/a: S W IRA: N N Driveway permits <br /> ADDRESS: / 1 J / ��' I (state,county,town) <br /> C 3 2 � Cu.bU Vc // �art�., w- 5S35Z q ®Sanitary permits <br /> CSM: �� LOT • SuIDNISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION - AFF REVIEW <br /> PROJECT DESCRIPTI°pl' / 0 <br /> S6-44 (GAT — Pc k CQ✓ 64r 1D� ---1-. 0 .1Z <br /> ' _ ailing District <br /> . ZiThis project is a new building or structure. • -ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. i <br /> SANITARY SERVICE: il PERMITNUMBBER�: ❑ Rural <br /> (EWER DEPTIC 13 ` zo 1 z -* 041472 (new existing <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> /5'' i ❑ Wetland/FI ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorela attach ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) permit <br /> BASEMENT: 1sT FLOOR: ❑ Erosion • ,•' <br /> N 30%X ZS. +, TOTAL SQUARE FOOTAGE: +, (slopes, .'. urbance, <br /> 2ND FLOOR: 3RD FLOOR: `,/ 110 filling/- :Ss) '. <br /> /� !" ❑ Review Location Survey , `, <br /> ESTIMATED CONSTRUCTION COST: ♦ -�► ♦ -► ♦ 1 and available options. <br /> (Please round to nearest dollar) $ 2 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ao [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yeslo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? fires Dlo <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 ►j o ODon't know <br /> 7. Is this to correct a violation? [Yes ` a <br /> 41 ^ '— APPLICATION MUST BE SIGNED <br /> ��»Z(��) 14 (Continue on Back) -► ♦ -► <br /> . 1 <br />