Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Gro+,'rnc rk Inc oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 'Mt E kitr -1> S 51 Se.CGersan o''L S 35 9 n�rS� Deed Restriction; CSM <br /> ?o <br /> Variance(# ) <br /> HOME'HONE CELL PHONE E-MAIL ADDRESS <br /> (01 t'/ -7..02- U' S` IN G tletr '"S' 5 t'-t 5 . c a ITN e Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> e Plan including location <br /> AGENT ADDR C CONT-• OR ADDRESS of well/ eptic <br /> (City,State,Zip)) (City,State,Zip) etbacks <br /> PHONE PHON ❑Site royal from <br /> applica ownship. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> in PARCEL rontage drawn to scale. <br /> NUMBER Q-S-(77'08 2cc 0 9 'a I)CQtie-z o e 3,- 1 <br /> TOWNSHIP: SECTION: 0' <br /> TJVJA o f= Qtrri g- -1 '/a:ii'- '/a'/a: ❑ Drivew its <br /> ADDRESS: (sta , nty,town) <br /> q1 i Iqi I j 61 itivnZa o.r,c 1i11S itary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 9L3 '►� I public,dilib" <br /> PROPOSED PROJECT INFORMATION AFF�.r-,- <br /> PROJECT DESCRIPTION: t l f <br /> lUi nq vh 1-o CXi Si-A H�kk nq a �ol� c 1%4) f c S-to,-./.,/cm o{�en a pct ea,1/"nn oni District <br /> . ❑This project is a new building or structure. ermined Use'? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 1. Add L''''' <br /> EWER [EPTIC new `F i <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> {3 1 ❑ 1N td/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: ShorelanCt, (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ❑ EfOSionC© it <br /> BASEMENT 1ST FLOOR 3 X Z 1t 1 1 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> J t ♦ <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: r . Z <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ -♦ ♦ ♦ '♦ "♦ $ 3 0 v U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes MN() ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> ® <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EONo <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 to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ -► <br /> 545-112(4/08) <br /> . 7,0( <br />