Laserfiche WebLink
(Pa. 1? SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.colt <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> Lo <br /> tJ ( Z), )c 4 k iN.)SON nZ in atus; CUP; <br /> OWNER ADD SS (N ber,Street,City,State,Zip) <br /> cJ I' D Restriction; CSM <br /> ,M 7 O � L V �= <SA^J nC ariance(# ) <br /> HOME P O CELL PHONE E-MAIL ADDRESS <br /> 665 P 5 I v q 4,65 33,5 >2-4 ..4._.• . ,7 5/04/ 1---"-)e ❑Site P�n�/dr��-to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and ificlbtjeg dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Planding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Seiks <br /> PHONE PHONE CI Site Pt n : .1 : al from <br /> appli•.b -r•• nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plan to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevationroperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER 61.8 aLl o "Z 7`f j72.2_6 c/ 2 <br /> /TOWNSHIP: SECTION: <br /> ❑ P <br /> �1 /i /� '/4: l"� '/4'/4: J� (state, a u town) <br /> ADDRESS: I) <br /> 2$ & #4 L U ET $ N &i a r- nn <br /> o/U✓N ❑San' ry � C f <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pU lic, rl �'�// 1 <br /> vo <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> J )-X ?o ❑ Zoning Di Viet <br /> ict <br /> \OThis project is a new building or structure. ❑ PermitteV4e? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUralVdress <br /> FIEWER rEPTIC (new/e fisting) <br /> HEIGHT IN FEET:_ NUMBER OF STORIES: (Not including basement) <br /> G/J ❑ Witi i..91113At <br /> AREA TO NEAREST SQUARE FOOT: Sh (atta hment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: / ❑ ErosionControl permit <br /> g`yo ,, TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: // filling/access) <br /> 9 7) , o y <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ,, � o '5 and available options. <br /> (Please round to nearest dollar) —I, —O. -0 -0 —I. —I. $ !/ 0 0 b <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? /alb es ❑No ❑Do fclli 1 ti- <br /> 2. Is there a wetland or floodplain on or near the property? Wes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Aes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes cORlo <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 iNo ['Don't know <br /> 7. Is this to correct a violation? [Yes valo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/08) <br />