Laserfiche WebLink
ZONING. PERMIT APPLICATION .countyofdane.coiYl SUPPLEMENT to Web�App># <br /> tit►tli�w . <br /> FROPERTY:OWNEWINFORMATI 0 4 ,`z gl... Win_ tri MI.te_ S`-- -S CUSTOMER TO PROVID • <br /> OWNER NAME <br /> -e r ri,�v, -�O vVN e S ��4 Zoning Status; CUP; / <br /> O R ADD S (Number,Street,City,Sta e,Zip) �3�3 <br /> Deed Restriction; CSM <br /> 3`-V d\ c- "k _ v,C3--___-W\0Ak� fi <br /> , t SFD7 ( . Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADD ESS Lp <br /> ,t e- , 3.S 1 1 - a _al c 2 Site Plan drawn to scale <br /> 'AGENTjINFORMA TIOitI;�•' �. 5ytt �CONTICTOtt`INFORiIIIigTION -�_,y, ,I jY and includes dimensions r <br /> AGENT NAME CONTRACTOR NAME L <br /> �Q 1,1) -2 QS �. ►h t') Sit y.-.: uding location <br /> AGENTADDRESS CONTRACTOR ADDRESS • well/septic <br /> (City,State,Zip) (City,State, ip) ' <br /> l� Setbacks 3 Q/2- yc- <br /> PHONE PHONE X51 Site Plan approval from 4/ <br /> - applicable township. i <br /> 9 0 Z 037z-es Y -56V 'Floor plans to scale ' // <br /> `PROPERTY/LOCATION-1 FO 41:0 >' hit -:I/accessilane co,dane:iiln.usl s' ni <br /> PARENT PARCEL NUMBER: CURRENT •NING: ACR GE: Elevation of property <br /> ❑PARCEL 1 , t I 0,_/ y�37 •• -•- drawn to scale. <br /> NUMBER !�b `I_ U. <br /> TOWNSHIP: . - SEC N' _ <br /> '/' 1/a'/a: - ►1 Driveway per <br /> �� `c')\� ! 4' state,coun town) <br /> ADDRESS: / a_ C S ride r\ v1/4 I� . <br /> CSM: LOT SUBD SION 'O •� Sanity •' <br /> f k s (public, private) <br /> PROPOSED PROJECT INFORMATION ' , : .- _ _ SJ JI R ` ' <br /> PRT ON: yr� p <br /> . This project is a new building or structure. =, <br /> If�ed�� - <br /> This project is an addition/alteration to an existing building or structure. ka � --4 W ':� rO✓ <br /> SANITARY SERVICE: PERMIT NUMBER' 4. •• e 4 id r <br /> EWER �( EPTIC ��' �� �DY'"�5` n'g� <br /> HEIGHT IN FEET NUMBER OIL STORIES; (Not including basement) 03„� ;}�4T�?"' <br /> AREA TO NEAREST SQUARE FOOT T r {9 ?� -*� <br /> (Outside dimensions including unfinished area attache �rar s and above grade decks or porches) � -:- --'-?- ,- ;, <br /> �BASEMET - - 1ST FLOOR: C& `- '- � a <br /> r I 9� . I TOTAL SQUARE FOOTAGE: j, c4 f <br /> °' <br /> 2ND FLOOR: 3RD FLO 9 ll i-, -,- - :-`: <br /> ,/ <br /> F _ 2 <br /> _ -1� <br /> e , i } <br /> ESTIMATED CONSTRUCTION COST: per_ m -" � / <br /> (Please round to nearest dollar) "� "♦ ♦ "� Z �� r �� � Y _ - __:. /(��p� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ' ❑No.' ❑Don't-know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ❑No .❑Don't know . <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes alo. . _ <br /> 4. Has there been a zoning permit issued for this pr-ope in the past 5 years? ❑Yes ❑N9 • <br /> 5. Is this project associated with a rezone/CUP/varianc (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes END V ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No - <br /> • <br /> APPLICATION MUST BE SIGNED <br /> • (Continue on Back) •—■ —i. -4- <br /> 545-112{4/0B) • ' <br />