Laserfiche WebLink
. )r// " l for,,„- Arei An r n, -e)1(e ss 1014i) <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTO R TO PROVIDE <br /> OWNER NAME <br /> -J-L-4.4) 13'1- kte_. oning Statu 4:01 6_, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re(tric�i0_�1,, S M ) <br /> AMC/ n �+e 1 O �l�Z . ra�2 c c K L AJ 7. S�35 01 �3 3 {Zi <br /> 1 � Variance # <br /> HOME PHONE ELL PHONE E-MAIL ADDRESS cli <br /> 6o 0 t7/5--'19/ -j t ke-C efi n1f;e:.e-c•tit drawn to scale 'I^ <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> / 6 Jrti$T, Le--C-- 66 14e r7 . Lc c ❑Site Plan including location <br /> AGENT ADDRESS C9NTRACTOR AD RESS of well/septic <br /> Al r) <br /> /036 �/c es f 40 /634 A f cre -f 1--/-' <br /> (City, �c� <br /> e,Zip) .-- (City State,Zip) etbacks <br /> 0/c' o,.l L� .53.91 s. O R Ec,aJ 1417- -35"> y <br /> PHONE PHONE/ ❑Site P ' royal from tQ �(91� <br /> 60 . .7/01-0 V7–(9 bog /9--e Y a Li applica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS L • <br /> I/4Ca f- err - 4G(- �C, ,\ VAcu 1-7`on eL 45&6(. Le.'tn Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Vatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P ►ty <br /> El PARCEL <br /> 05-09-G W–Y6$0. t-) 6, I -7/13', 2.v/ 4c . rontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTIggrr��: - �li ` <br /> Q, e_�onl "f +/.: +/4+/.; A 1rivewaypermit iJTn <br /> ADDRESS: / (state,county 1 its <br /> CS 13 i e LOT -1-,\ ,,,\ SU DIVISI N 17,- prJ. <br /> t LOT Mranitary .- <br /> /-i 3 D o (public, . i <br /> PROPOSED PROJECT INFORMATION 3_,TOSF REVIEW <br /> PROJECT DESCRIPTION: <br /> /V u,, b u ; ( d , "x( oning istrict <br /> [ his project is a new building or structure. ebmitted Use? <br /> ]This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT UMBER: n(�`�r 11 Rural Address <br /> EWER JEPTIC I — )O / —0( may/ j (new/existing) <br /> HEIGHT IN FEET I t, �J , NUMBER OF STORIES: (Not induding basement)/// I� <br /> �3 K / w- - d/Floodplain/ / <br /> Shore!- .r(attachmen " J <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) A <br /> rosionControl permi <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4.. (slopes,disturbance, — d <br /> 2ND FLOOR: 3RD FLOOR: g fillip cress) �i� <br /> 35-6 E eview Lo "on Survey Gj <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available ptions. J <br /> (Please round to nearest dollar) $ 9ffJr CO D <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes EINo Donnnow <br /> 2. Is there a wetland or floodplain on or near the property? QYes ao ElDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? aes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ao <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 I.lo ['Don't know <br /> 7. Is this to correct a violation? QYes alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -♦ <br /> 545-112(4/08) <br />