Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r 1 <br /> — A °' 0 E9EIz• oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zip) Deed Restriction;CSM <br /> 5137 M a avA Lowe At(so4 I41 531 5 Varia ce(# ) <br /> \Z----HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Of-3,S' 13: Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON RACTOR NAME <br /> .1Aia,-) FzitA7 .t.. IA,Rr 6E62191-E Quui.PExsi -IW:. _ ❑Site I including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w eptic-- <br /> (City State,Zip) (City,State,Zip) Setbacks <br /> IN4toa 0 (AI 535b2 <br /> PHONE PHONE -- ❑Site P n pproval from <br /> Vel-t 31-44W 1 appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TresaszkAJ 0 moos GE s(mow. coµ„ s Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://ac'cossdane.co.dane.wLus/) levation of property <br /> PARENT PARCEL NUMBER: CURRE ,T ZONING: ACREAGE: P P y <br /> ❑PARCEL .�/ p y frontage drawn to Scale. <br /> NUMBER IVgQ D-1T•-��CO'' 4- J <br /> TOWNSHIP: SECTION: <br /> Du NN) 1, 1/: NM 1/�/: SE ❑Drive ermits <br /> 4. 4 4. <br /> (st e,c unty,town) <br /> ADDRESS: <br /> 279.? (o(wow Co)I1-T <br /> CSM: LOT SUBDIVISION 1 i ((BLOCK/LOT El Sanit. .ermits <br /> b (p c, .rivate) <br /> 0 G <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> I MD RAT(04/ Qvirda .Eu) -40464�,,..,ry gESiii -E oning District <br /> . , is project is a new building or structure. CaPefrnlied Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER- Ira)Address S W /r <br /> EWER 1EPTIC .,,/ / (new/existing)/y/l , /S--Li r—y,�[ <br /> HEIGHT IN F T: /� NUMBER OF STORIES: (Not including basement) I� ° `"'��77 <br /> i 1 S /11 - r- , -••/Floodplain/ � <br /> ARE NEAREST SQUARE FOOT: Shore a attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> osionControl permit <br /> BASEMENT: IOC, 1ST FLOOR: 1 TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 3.436 6/ E 31$S filli /access) <br /> 2ND FLOOR: 3RD FLOdR: n <br /> $7 I .�'2 eview Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST: ♦ ♦ y ♦ �ZS �O� and available options. <br /> (Please round to nearest dollar <br /> ,-� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eg es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [:`'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes E No <br /> 5. Is this project associated with a rezone/CUP/variahce(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? Des ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />