Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �J� r ' o /5 ,iii Zoning Status; CUP; ~l�x <br /> OWNER ADDRESS (Number, treet,City,State,Zip) . <br /> n �- Deed Restriction; CSM <br /> 6'l, % r/ U 6° �p���'►.1U r �"(/-� _3.59% Variance(#.,234,29 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Ip;-L/%j 9. 7 fi/u/So r!' 9t//La Hipp. Oy7'J 11 Site Plan drawn to scale 'O` <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME . // D <br /> ,SteWell S 0,, n�1c,i Poefle ET Sit- _ -u: sing location T <br /> AGENT ADDRESS CONTRACTOR ADDRESS of -• <br /> U ()3 5"--I nS pc _ <br /> (City,State,Zip) (City,Stpte,Zip) Setbacks C 3/3�02 ����� <br /> S_JJ2"'vr,- $ Pei l nfi <br /> PHONE PHONE L 1 Ite Plan approval from <br /> e77_ i/, • gs x// applicable township. L IA P <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> n ro#1. 5 bOr5d9p,,1 OvnPye Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) 7m <br /> PARENT PARCEL NUMBER CURREN ONIN ACREAGE: Elevation of property <br /> ❑PARCEL es-,2 ...../7/.....9,500�2 ( �K //� frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: C SECTI : <br /> J� IA: /T 1 ,/4,/: Driveway permit <br /> ADDRESS: <br /> (state,county.Q <br /> ?a 7 40aA '' i44''✓ # 1 ( _4.57,x,71 SSanitary :._:- <br /> CSM: LOT S DIVISION BLOCK/LOT <br /> (public, <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1)e u) S� n q 1e ,i r)-)/,�V A p y)i-e Zoning District A <br /> ®This project is a new building or structure. , ,7 Permitted Use? E C d Q P <br /> ❑This project is an addition/alteration to an existing building or structure. .- S <br /> SANITARY SERVICE: PERMIT NUMBER: • Rural Ad. : s u r <br /> EWER JEPTIC /S 00/6-0 O c7?4C— (new/' ' <br /> HEIGHT IN FET NUMBER OF STORIES: (Not including basement) <br /> `' iv — 6 Wetland/Floodplain/ / <br /> AREA TO NEAREST SQUARE FOOT: horeland (attachment) 'V <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: permit <br /> / qg-' 2 re-D + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, 1 a i <br /> 2ND FLOOR: � G� 3RD FLOOR: �2�L/ filling/access) �� <br /> !!/ ail ! <br /> Review Location Survey r/ <br /> ESTIMATED CONSTRUCTION COST: 33;7000 `and available options. 74_. <br /> (Please round to nearest dollar) -♦ -♦ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes JNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes INNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? []Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes ❑No <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 EINo ['Don't know <br /> 7. Is this to correct a violation? <br /> es Do <br /> CATIO MUST BE SIGNED <br /> 545-112(4/08) (Conti e on =ack) —► —► —► <br /> gm /---/ 9 'I. 0 c <br />