Laserfiche WebLink
ZONING. PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to�Web�Appa#= <br /> (PROPERTY OWNER°INFORMATION <<a.`t ilatit4161 - _� h'-s m ._`3.gav- CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jd/'N I f 7e / 1 I Zoning Status; CUP; <br /> OWNER ADDRESS (Number,r,Street,City,State,Zip) �� W/ Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60,47 /IS SZe/ n Site Plan drawn to scale <br /> °AGENTj1NFORMATIO "`�" - <br /> y and includes dimensions <br /> ., .. . .._ _ �,,.,-_. 2...���� .�;r� ��CONTIIACTOItry1NFOR �TION�.a �����k- <br /> AGENT NAME CONT5ACTOR NAME <br /> Jd/frv 'S'// A d 'A-' .7 9 - n Site Plan including location <br /> AGENTADDRESS CONTRACTOR ADDS /3c',e 4// • of well/septic <br /> Pto <br /> (City,State,Zip) (City,State,Zip) n Setbacks <br /> Oe, d--2iaY 't'( S-25-1 2 <br /> PHONE PHONE ❑Site Plan approval from <br /> 60e 516— 3-7, 6e 8' sV 2-ccit applicable township. <br /> E-MAILADDRESS E-MAIL - • <br /> • n Floor plans to scale <br /> `=PROP[RTY/LOCATION_INFORMATIONY:(http,//access'dane.co,rbne vin as1)i'� :, n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT-ZONING: A. ACREAGE: <br /> EiPARCEL RH-t ?G.-4t-e , d frontage drawn to scale. <br /> NUMBER US^D`! 272 26l9� 1• pct /Moue .., <br /> TOWNSHIP: SECTION: A�� n Driveway permits <br /> 2.-.9 ��: �4�4: N� <br /> ADDRESS: / (state,county, town) <br /> c'c Fr%e i4 ""'t/ ' '2 �Z / n Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> Gy (public, priivate`)`y <br /> • ; . • 2 1 • ; I - . i ; 11 _ • L '-- {':S.TA�' REVIEW� <br /> PROJECT DESCRIPTION: P�jF ,r®'Y,h 01� �@ �tC : �.t !- £ _ � V- <br /> 1/ ' B..-fry w7` ewe r)�.,h Lt/1'2i2 MOB sTr4c 4 �� <br /> • This project is a new building or_structure. = � =' �F `'fi'"� :- �' <br /> 0 P J 9 T iP. errnitfied Us�'� f <br /> ['This project is an addition/alteration to an existing building or structure. ' * W"- g <br /> SANITARY SERVICE: PERMIT NUMBER: 1 W�� <br /> {���IT,aI-AdCIreSS� - <br /> EWER REPnc k '( ew e"xt . a ti 4 75.141 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) `= = ", ..r =t <br /> 'WY 1lar�d/Floo1) .Ibt E} <br /> - ShokafdIti-tta -o -it rk <br /> AREA TO NEAREST SQUARE FOOT: 5 ` <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) � �_, wa - 1 <br /> ti- ECoslo C- rorpermit a <br /> BASEMENT,' 1ST FLOOR: -.� 4 �M• <br /> j• TOTAL SQUARE FOOTAGE: 4, � 6�3 5. Tap U,' ; <br /> 2ND FLOOR: 3RD FLOOR r g�4CCeS , ,'t,- <br /> • <br /> L g ftP-V La0attag rgi <br /> • <br /> ESTIMATED CONSTRUCTION COST: . <br /> (Please round to nearest dollar) c--0 j y 'k = <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ' lEINo.• fDon't-know <br /> 2. Is there 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 and are they in agreement? EYes QNo. . _ <br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? Yes QNo . <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) [Yes Do ['Don't know <br /> 7. Is this to correct a violation? QYes [ l° . <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —■. —► —is <br /> 545-112(4roB) - <br />