Laserfiche WebLink
ZONING PERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU'TOMER TO PROVIDE <br /> OWNER NAME <br /> a--than d- (\ei Nc/�nbve."c-fl I o mg Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D d Restriction; CSM <br /> -745(0 k;d4-66 R.4 Wa...••"—t• , w II $3311 V riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL Am DRESS <br /> ga -3 `t 5-33o-13 1 - ep Ikai'...,a.‘ ,cx•-- 0 e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> &'.4' ap g.t east... 2v..dA41..-� a Plan including location <br /> AGENT ADDRESS CONTRA TOR ADDRESS o well/septic <br /> S03 Lex�4•s. Dc SC3 Lec,-.-stc, b.c. <br /> (City,State,Zip) (City,Stat Zip) etbacks <br /> Licw-.g 14-c- s wL 53SI'l " . • r- 535`!1 <br /> PHONE PHONE ❑S' Plan proval from <br /> CAA-- Dili - Dcs I (.70g all -a4 51 a lic a township. <br /> E-MAIL ADDRESS E-MAIL AP DRESS <br /> -,, ..„ J.J ® -rns •nib c.:- r- ,, t dip "MS.nc4- loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CUR ON ONI G: ACREAGE: 4ation of property <br /> ElPARCEL ^ <br /> NUMBER O$b5�itolCtl71/4{cc --7,at ro age drawn to scale. <br /> TOWNSHIP: SECT!••, <br /> 1� e • , N '. 1,04.. 6 tij D iveway permits <br /> ADDRESS: ( tate,county,town) <br /> ?tea 41 K ( LkG • a VII <br /> CSM: LOT SUBDIVIS ON BLOCK/LOT nary permits <br /> (,,ublic,private) <br /> PROPOSED PROJECT INFORMATION ,TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> M.../ IIor_ VJ f A© R^ Pli IN o 0 ning District <br /> • <br /> This project is a new building or structure. IM "emitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: of : r- Address <br /> FIEWER PEPTIC 1 3...701(0.. 09 (ne existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,a y I (1---• ❑ Wetland/F plain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shore d (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCOn permit <br /> I goa <br /> Olt. 30-1 to 1 TOTAL SQUARE FOOTAGE: , (slopes, [urbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/ SS) <br /> y8�g 1 <br /> ❑ Review Location Surve p) <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ —0. and availab e options. v <br /> (Please round to nearest dollar) y ,000 0c) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes o QDon't know <br /> 2. Is there a wetland or floodplain on or near the prop rty? QYes o EDon't know <br /> 3. Have you talked with the township about your proje t and are they in agreement'? IZfres .No <br /> 4. Has there been a zoning permit issued for this prop rty in the past 5 years? 7 QYes QNo <br /> 5. Is this project associated with a rezone/CUP/varian a(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes ElNo EDon't know <br /> 7. Is this to correct a violation? QYes I No <br /> A PPLICATION MUST BE SIGNED <br /> f 545-112(aioa) `y I s r e-s (Continue on Back) <br />