Laserfiche WebLink
59' <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROP7RTY OWNER INFORMATION <br /> OWNE- CUSTOMER TO PROVIDE <br /> I <br /> i..�,a. • • 1 <br /> OWN'RAD.' SS (Number,Street,C I - Zip). `.����IL�' ,� <br /> ❑Zoning Status; <br /> /�y ''` - '-• �1 / Deed Restriction; CSM <br /> HOME PHONE CELL PHONE ..a1_,„i ��... �I 535-. 7 Variance(}��_ <br /> E-MAIL ADD;ESS ) <br /> AGENT INFORMATION I, ' ' •-i - . - 4 'i • a Wt <br /> CONTRACTOR INFORMATION ❑Site includes drawn to scale C <br /> ACTOR N and includes dimensions �AGENT ADDRESS <br /> lip- <br /> CONTRACTOR ADD' S.4 n 0 Site Pla I luding location <br /> (City,State,Zip) 6 .L.; ' - • <br /> Lt-E-126" <br /> of well/s tic <br /> (Cit State Zip) , <br /> ❑Set cks <br /> PHONE �'7 <br /> CUL S 55 / <br /> PHONE <br /> El Site P <br /> ,0E- 839- 7,� to oval from <br /> E-MAIL ADDRESS <br /> appli I;to, nship. <br /> E-M•IL AD.RESS <br /> PROPERTY/LOCATION INFORMATION (http://accessdan clan wi.us/�6 Floor plar�5 t�scale <br /> 0 PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevatio of pr perty <br /> PARCEL <br /> NUMBER D7// • O 3y-�- S - a <br /> TOWNSHIP: /2 c(°f frontage r n to scale. <br /> 1 SECTION: <br /> ADDRESS: 1 RO� �� ��/: S c Drive, y�p:�,,�' <br /> 0/(2C 0°' 1 C , -yL (stat !cbu/ty, own) <br /> 2C - <br /> CSM: LOT 4its- <br /> S S- SUBDIVISION BLOCK/LOT ❑Sani . ', <br /> PROPOSED PROJECT INFORMATION 11m iCgn J�erir.� ��f a (publ , ,, e) <br /> PROJECT DESCRIP N; STAFF REVIEW <br /> • ❑This project is a new building or structure. ❑ Zonl istrict <br /> [This project is an addition/alteration to an existing building or structure. ❑ Permit/ se? <br /> PERMITNUMBE ❑ Rural Address <br /> ■. v. P . 0 <br /> HEIGHT IN FE;T ! • (new/exi�fls'o`'t <br /> i C /de p i! NUMBER OF STORIES: (Not including basement) �� <br /> 'J ❑ Wetla .ldplain/ <br /> (Outside dimensions including unfinished hed aea attached garages FOOT:above grade decks Shor . k chment) <br /> 1ST FLOOR: , s�r porches) <br /> ❑ Erosio�ln rol permit <br /> , TOTAL SQUARE FOOTAGE: j (slopA�4 1i nce, <br /> 2ND FLOOR: 3RD FLOOR: 1�(- <br /> / filling ac s ) <br /> ESTIMATED CONSTRUCTION ONSTRUCTION COST: �` <br /> (Please round to nearest dollar) ❑ Revie L Survey <br /> -► ♦ -♦ -► ♦ -► OoC� andaa'a <br /> I options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? la es rp <br /> 2. Is there a wetland or floodplain on or near the property? El Yes �4-�"0 �on't know <br /> 3. Have you talked with the township about your project and are they in agreement?., E PA res ° �on't know <br /> 4. Has there been a zoning permit issued for this es o <br /> 5. Is this project associated with arezone/CUP/variancerty in the past 5 years? � es �° <br /> 6. Is a location survey required? (see reverse) (petition/appeal# ) (leave blank if none) <br /> 7. Is this to correct a violation? Ves �o [Don't know <br /> QYes ONo <br /> us-tlzta/08) CAIU <br /> (Continue APPLIT ON on Back)MST BE SIGNED <br />