Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTCER TO PROVIDE <br /> OWNER NAME <br /> Q[ /l �U o l� Sr l7 m i oning Status;CUP; <br /> V OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /t0/ Y'/iA,efr 4iw]�' /,Ale c agent/ GJZ. 535-9 j Variance ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ,239- /3Y6 ' e Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> hie A,s6 it) avr 14 X .rive• /1/4,v5&ti I e i dcl✓fms ,ryc • de Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ is <br /> i/o841-i,4 -A 5'.168 I/O 60444-le. svit 6 <br /> /ity,State,Zip) (City,State,Zip) tbacks <br /> wOON�/r o w7. f15 7 A.40A t ksf wZ. 5-3 S-'7 <br /> PHONE PHONE D Sit pproval from <br /> 60E-M/i-4 >3 6 O— 8v -%73G ap ' b township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /6�JSEny +v�/�>!,rs COs. ,viT `i/use,vb.,/disc 7lJS • �v£r F or Ranstoscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P <br /> DPARCEL 0 7 p/O 70i-32 f yd y)-. A-- Sj0 frontage drawn to scale. <br /> NUMBER J <br /> WNSHIP: SECTION: <br /> /n i11f�l�a�v 3 1 1/4: S w '/<'/4: 5" riv permits <br /> ADDRESS: / (sta , tin ;,town• <br /> �s0 / f£/AIAi Ally ,�_ nifiarypeo.' /ç ,, <br /> CSM: LOT SUBDIVISION BLOCK/LOT 4rni <br /> (pubhc�� <br /> S" foe 4.0",le/cs/sus ,k <br /> PROPOSED PROJECT INFORMATION EVI* <br /> PROJECT DESCRIPTION: ,, t ' <br /> � 06- 4� <br /> S/.vf/£ cArn i/y /e-ei,e f f <br /> . [.This project is a new building or structure. 8 ems • <br /> ❑This project is an addition/alteration to an existing building or structure. v: W x <br /> SANITARY SERVICE: PERMIT NUMBER: 4 - .dress : r <br /> . 4�EWER EPTIC /3- o/S- 003 al i ' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) _,,g-i <br /> . 33 / ... yy ' <br /> S)']OOr s-p. :in;c1�L)'j <br /> AREA TO NEAREST SQUARE FOOT: i - <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ,J,0::::::,--,FOS . . „a t ,, <br /> BASEMENT: 1ST FLOOR: <br /> O` / .4 u2 6 f j TOTAL SQUARE FOOTAGE j - ('sus,. '% disturbance, <br /> 2ND FLOOR:6 3RD FLOOR: ;a ® y <br /> euiew ,�=or due• <br /> ESTIMATED CONSTRUCTION COST: and , p i <br /> (Please round to nearest dollar) ♦ -► ♦ ��D� 000 <br /> y e_s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies [ o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes EN0 DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes 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) ['S'es 'lo ['Don't know <br /> 7. Is this to correct a violation? Dyes [Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -o. <br /> 545.112(4/08) <br />