Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> oWNE ^�/ <br /> le LLv1A T e YIe I 'I <br /> OWNER ADDRESS ( umber,Street,City,State Zip) Op �I�-rl e / Zoning Status;CUP; / <br /> Deed Restriction;CSM 7,75 <br /> 12 /0 f u AI v t goat( O r n n WI J 37 7 J /ariance(# ) <br /> HOME PHONE CELL PHONE / 4,401AILADORES$ <br /> p: YIN- 4/*D s p ie t ck �' L104 1at/.co 44 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S CC IT P_ 2,( 4 IQ ye_ to Plan induding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Lp) (City,State,Zip) Setbacks <br /> PHONE PHONE it lan proval from A%4. <br /> livable township.ap <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of property <br /> ®PARCEL or - o6'to - o R 1.4 7 ile frontage drawn to scale. <br /> NUMBER g2.90a0 L <br /> TOWNSHIP: �� SECTIQN: ' �} ,O _.c ❑Driveway I <br /> it aH(J{ G/{ �: _ ���4: 7d-U> (state un CD <br /> ADDRESS: <br /> 21 a . a Q- �• : 4 0 r _ /A I 3 7 ❑Sanitary :=•••.ts <br /> CSM: LOT S .,•VISI• BLOCK/LOT *1��, <br /> 94 8 L 3 (publi <br /> PROPOSED PROJECT INFORMATION -TAFF REVIEW <br /> PROJECT DESCRIPTION: ( - 0 N <br /> 5.- o r � 1i (A.1 II I C t iy p e r„ L A, V 1. ►' 'oning District i i; <br /> . This project is a new building or stru�Rure. 4-rA G.1-• r A h► r~. la 222k <br /> / m Permitted Use? <br /> ['This project is an addition/alteration to an existing build oerrsrk ure eY /e&- <br /> SANITARY SERVICE: PERMIT NUMBER: , 04 Rur al A••HEWER EPTIC f'\ (new = stin HEIGHT IN FEET: NUMBER OF STORIES: (Not indvt, s4eir basement) j� <br /> 7I 1 ,Wetland/Floodplain/ / <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , , <br /> ••sionControl permit si <br /> BASEMENT: 1 J/H 1ST FLOOR: i TOTAL SQUARE FOOTAGE slopes,disturbance, /" 4 <br /> 28 X 4/0� j filling/access) <br /> 2ND FLOOR: 4--11V--'/ 3RD FLOOR: <br /> �! 4 /V A /(e,g 0 Review Location Survey r j 6 <br /> ESTIMATED CONSTRUCTION COST: �O <br /> (Please round to nearest dollar) -4. 0 ♦ ♦- ♦ $ 30 o e o and available options. <br /> -, <br /> / 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ge EJon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes tlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Do <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 Olo DDon't know <br /> 7. Is this to correct a violation? ❑Yes [ ,lo <br /> APPLICATION MUST BE SIGNED <br /> 12(„�, 441`K) (Continue on Back) ♦ -t. -I. <br />