Laserfiche WebLink
SUPPLEMENT to.WebAPP#' <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> -PROPERTY.Y OWNER:INFORIYIATION `. ` ' i ' OFFICE,USE.ONLY . <br /> OWNER NAME <br /> 7.)Rtk'ev' Q 0 \SQ/� ❑ Zoning District ° <br /> OWNER ADDR SS (Numb Street,City,State,Zip) <br /> cO e ' i Ci pv(61tTU t v 1 53SS-9 ❑ Perm i d'Use? <br /> tte <br /> PHONE E-MAILADDRESS <br /> J, 0 lt CUP;AG�ENOT 6'FORMA3 TIO`N 5°1�! : . CONTRACTORINFORMATION I �.,, , Deed Resr ctionC <br /> SM <br /> ) <br /> CONTRACTOR NAME <br /> NT NAME Variancer(# <br /> rLAane 12- fi <br /> AGENT A DRESS CONTRACTOR ADDRESS ❑ Slfe Plan'draWn,tO SCale <br /> 5\Dt0 ee,tn� and includes dimensions <br /> (City,State,Zip) (City,State,Zip) - <br /> 5,1Y\ p(A t(■e awl 5 3 ]D ❑ Site Plan Including location; <br /> PHONE PHONE of well/septic <br /> E-MAILADDRESS E-MAILADDRESS ❑,Setbacks, <br /> b� ah �y►�. � C�� ,n ;` <br /> PROPERTYlLO _,..,. ;. : ,r,. .. <br /> CATIONINF,ORMAT.ION;!(httpeNatcce5sdaneco.danew�:us/), ❑ Slte Plan approval from <br /> PARENT PARCEL NUMBER. ZONING: Q 1� ACREAGE: a applicable township <br /> Li PARCEL C/D10—aloa—q(�Z)-3 1� r OOnn�� <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑ Rural Address <br /> ��nn a O '/4: Le--) 1/41%: S� . (new,[exlsting) <br /> ADDRESS: <br /> ,6„ Qerc h CT S-'-o v+�h c c l u\ ❑4Floor plans to ScaleY <br /> CSM: LOT S DIVISION BLOCK/LO i" ' <br /> 00 t S 1 ci 1 v1 U ttlevatlon of property <br /> I1; .11.�. ,]1J:1'114 i1;1 4];ad,1_1i[.l; ' <br /> N'_ ` frontage drawn to scale 44 PROJECT DESCRIPTION: 1 X ( <br /> C s s; <br /> (ems t c 'I IA tL1 rS D fDrrvewa�'perm is <br /> (Mate, county,town) <br /> l'This project is a new building or structure. mr <br /> ❑This project is an addition/alteration to an existing building or structure. ❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: ublic,p('vateq+ <br /> IikEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) W- tland/FIOOdpl3ln/ <br /> I Si�oreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: "' " <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: ,�� I (S1ope dsturba tce, <br /> j, TOTAL SQUARE FOOTAGE: I kY y <br /> fllling/accg's°t;) <br /> 2ND FLOOR: 3RD FLOOR: xr t a <br /> 37 y0.Review Location Survey•ESTIMATED CONSTRUCTION COST: A�� and available options <br /> (Please round to nearest dollar) <br /> 1 The property is within 300 feet of a stream or 1000 feet from a pond or lake? C.1 Yes °Q No LI Don't know <br /> 2. There is 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? -Yes CI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®-No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes (�No ❑Don't know <br /> 7. Is this correcting a violation? CI Yes 'lo <br /> T SIGNED <br /> (Continue APPLICATION on BackMUS) BE-1 —► <br />