Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUST R TO PROVIDE <br /> OWNER NAME <br /> l� c-i Siouk c-4s65.pu oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State Zip) Deed Restriction; CSM <br /> (017`/ -Su� 1/ S" rAeKz`- A 6�t Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • JS -"qg D.24 Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> .LrtC.Ejt) �uza rc ,8y11bE,e S ite Plan including location <br /> AZtate,ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ( Zip) (City,State,Zip)�p etbacks IAN <br /> PHONE PHONE H Site Pla pproval from <br /> 8' _ /Psz3 app' ble wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ol- .S 1 •t• N ger i A3 E,-- $I r plans to scale <br /> r <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: R T Z0. G: ACREAGE: P P y <br /> PARCEL �� ��7/ g frontage drawn to scale. <br /> ❑NUMBER 6�� 3�3 �7' D`0 <br /> 0 <br /> TOWNSHIP: SECTION: <br /> Vgi_D0}- .E� 1/4: p 0 %IA: S w ❑ Drivew rmits <br /> ADDRESS: (state u ty own ` <br /> 1 61 / . kik Oa 4-7— 11 anitary permits # • I, <br /> CSM: 'o LOT • SUBDIVISION BLOCK/LOT lib(public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION:s , ' <br /> Kly'/Zoning District <br /> This project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> fl -- ; Address <br /> DEWER [EPTIC /3-alo/ 6/)611/ — new :xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> W-/a�s / Wetlan / odplain/ <br /> Shor a (attachment) <br /> A EA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Erosio C rol permit <br /> �'' 'g� �3�` y j TOTAL SQUARE FOOTAGE: 4, (slop , 'sturbance, <br /> 2ND FLOOR: 3RD FLOOR: full aCCe S) <br /> �- 7-2 o <br /> 6 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST SS(12)/<- and available optio S. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ <br /> 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes 21NNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? fYes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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 [ Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />