Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> ' PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME A62.0_1<4, 10 A- I <br /> &NO K:1 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) n <br /> IU$c./S ft.t)c MoLw-7A /1VE.vte &Loc MoL)A)L Wt 5.35 9 geed Restriction;CSM <br /> ,v <br /> Variance(# ) 0 i <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 --73G-z. 115 - i q N a h(,c,1 0 M k+c . het Site Plan drawn to scale / - <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> jLLt.LAM ,ijgRawo Ct) -roM (,O,Js7. /AA,. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / of well/septic <br /> )atti8 &.u6 1A9i, Av&. !oggg 131-QQ, M«UArAtAl Ai/e <br /> (City,State,Zip) (City,State,Zip) — aSetbacks q4f63'/�'0 <br /> tU6 Mo 5 l IV. S'3517 CZzw4 MO uA D W. 53517 <br /> P ON P ONE Site Plan approval from N/A-- <br /> 0V i-25— /t ti 9 ((0 0 8) 2�5— /9 y 9 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> . t (a v , 4-`' A _ • tD M ),,'f'C. ■ he-/- LI: Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> NUM ER 0(007•- rqI—910- o 2. `/77 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Sn•AA tJGlA� ��4. %��. It1 Drivewa .-rmits y _() <br /> O) <br /> 25�� ADDRESS: (state ,town)lig; <br /> uxrr? Wt 6+t WAY J V eitx )A Ill, 53533 Vj r l <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits �G 3S <br /> • 01 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: // <br /> Ne-W CQ.JS1-11-0 .t'(O/ll Ci JUG Le cA✓J1,IIr1r HO05ld• Zoning District <br /> 5This project is a new building or structure. Xpermitted tJ <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address ' <br /> EWER iEPTIC S20 35( (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Two „IC �„'. •odplaln/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> foreland `E ttachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: >`it l t�ostonControlpermit /iit2t7 2R7 3 Ito/5 , TOTAL SQUARE FOOTAGE: , slopes,disturbance, <br /> fillip /access} e , we), <br /> 2ND FLOOR: 3RD FLOOR: �6�3 0.0 6g S Ftevtew Location Surrrey `` <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) '--� - - - - $ 3 50� 000, 00 p ot1S,. N <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes No <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) QYes ao ['Don't know <br /> 7. Is this to correct a violation? QYes QNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -► <br />