Laserfiche WebLink
. A p to 3 6'22 „ <br /> „... <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY-OWNER:INFORMAT,ION ,, _ w=_.:, ,';''4 4 ff?;-,;,. .-E._.'< <,:?`.- t CUSTOMER TO PROVI E <br /> OWNER NAME <br /> Curt/.c P J ah h `►4 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) r t Deed Restriction;CSM <br /> 38 73 HWY /9 1 - •res A 535 3 Variance y <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ■ Site Plan drawn to scale j- <br /> AGENT INFORMATION - CONTRACTOR:JNFORMATION: and Inclus- s mensions fo <br /> 4—risn.NAME CONTRACTOR NAME <br /> J <br /> - <br /> Cn�J ) LA t+ c$�FLF I•Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> QZS7 ill cnr y :-CAc\ Dr, AO <br /> (City,State,Zip) (City,State,Zip) Setbacks 0 /0 <br /> De Fdr,.g7" e.vz S-5,5-3 Z.. <br /> IONE PHONE el Site Plan approval from /A <br /> oW Z y(5 - e96-) applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION<INFORMATION + (http:7/accessdane.co:dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL BER ON-6.3 -1 21- `/ . ` / 0 . 96 7 frontage drawn to scale. <br /> NUMO► <br /> TOWNSHIP: Q �/ SECT ON: Ai;D ule l�E '/a: /VW %IA: /1./ Driveway per�, 4 <br /> ADDRESS: (state,county OW <br /> 6a5- 7 Mh9l2Y TM alvC 0.1 Sanitary.- •tts Ell , e CSM: LOT SUBDIVISION BLOCK/LOT (publi• privat=) <br /> FRRAI CE P/1/2 K G+v Oa+ , / <br /> PROPOSED PROJECT INFORMATION, ;, . . . ' T <br /> PROJECT DESCRIPTION: � ��� -����� � � � ,i4_,2:1 : � � '-• � L� � " � <br /> ,s r� ► ��� <br /> A dd;-�i'a 7 �. ,,--- ! g t , <br /> ❑This project is a new building or structure. :h . ' _. 5 , 0 <br /> r, �'� �� 1 <br /> l9 Tt11S project is an addition/alteration to an existing building or structure. 1�Ym c� I �wr <br /> SANITARY SERVICE: �,/ PERMIT NUMBER: �' ��� ��:°04`- r -: <br /> ❑SEWER L1�SEPTIC NSA ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ; <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , i k r 4 <br /> BASEMENT: 1ST FLOG-• I � . ` g <br /> �D l��r <br /> /030 1 TOTAL SQUARE FOOTAGE: j - e6 £ t$. I't' ` 1 /; <br /> c 1 :fin "'a `07 _ <br /> 2ND FLOOR: 3RD FLOOR: /7 9 O <br /> 7 ESTIMATED CONSTRUCTION COST: � w <br /> ♦ ♦ ♦ ♦ ♦ '—► ,, "a.c..a '1, <br /> (Please round to nearest dollar) $ /OOH DOD '�� � ='1� ;=' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EtNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No L Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? L4es ❑�o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L✓1 No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? (see reverse) DYes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -4 -0 <br /> 545-112(4/08) <br />