|
1 i) ' , • ..---) „ ._, ,
<br /> SUPPLEMENT to Web-App IS
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER ME
<br /> /Wien e wo 1 7,2 ,,„, ,
<br /> ,. Zoning Status;o 4 (2)
<br /> OWNER (NyNt>e(
<br /> ADDRESS r Sireet.Ciy Sia:t.,Z..)4 Deed Restriction. CSM
<br /> 9(3(v trilAer KJ wars ha 1 i wi ,S,&S,S 9 Variance(4._
<br /> , '
<br /> i i•iiZitt-,PHONE CELi PHONE r ts^p,':AnnREss
<br /> 6/go- 7 63-67(20 0.2 Site Plan drawn to scaIP—':-2-0 q?
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions<
<br /> -;
<br /> AGENT NAME 'CONTRACTOR NAME /0, 22'
<br /> 7:9 191 tie r-1 g_Site Plan including location
<br /> -A3EN7 ADDRESS ,CONTRACTOR ArrRESS of well;septic
<br /> I:City State Ztc; .Cit:,Sate Z■pi Setbacks 37 (°4
<br /> ,.....
<br /> —
<br /> P?0N
<br /> ' 44 le" 'Cr
<br /> [PHONE E 13/ _,‘&_.,,T.
<br /> Site Plan approval from
<br /> applicable township.
<br /> E-MAiL ADDRESS E-MA1,ADDRESS
<br /> Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (httosIcoatarommLusd)
<br /> PARENT ,PARCEL NUMBE 1 CURREN r ZONING' 'AcTeFAGE sia.Elevation of property
<br /> —NPIAulai-L,R :Of/0-0 Si-P475-0 'VIP ( )„a) 43 8,EaS frontage drawn to scale. 1
<br /> R:
<br /> TOWNSHIP ;SECTION
<br /> Vor k , 74: 0E wt: Ai e ZDriveway permit
<br /> (state,county
<br /> ADDRESS
<br /> —76(93 De4„.. ‘,Ake Pa /114,-.5\,.)\ via-- -.A‘s s 9 rdil Sanitan .,;._2...,....
<br /> —6:S M' i SUBDiVIS,Ci: BLOCK 1:0 r (public altar
<br /> i.)05Lt
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> pRwEcr oEscRIPTioN
<br /> F4 r en S ,o e X Zoning District
<br /> This project is a new building or structure.
<br /> E
<br /> This project is an addition/alteration to an existing building or structure. xf Permitted Use? ,4/ 0/
<br /> ---4_ V'1
<br /> SANITARY SERVICE :PERM:7 NA,,IBER /I4 Rural
<br /> DE4'v'ER DEPT1c (newlkistin )
<br /> HEIGHT IN FEET ,NUMBER Of- STORIFS (.%() i,/t.,(,,I,r g;aserner
<br /> NdWetland/Floociptaini
<br /> Shoreland (attachment) A/A
<br /> AREA TO NEAREST SQUARE FOOT.
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) Ai-iv
<br /> BASEMENT 1ST FLOOR .....
<br /> t,YLL ros 1 on Co ntrol permit
<br /> .4, ,7-3
<br /> TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance,
<br /> GObC) filling/access) I/
<br /> 2ND iI LOOR :3R0 El OOR ( io
<br /> .
<br /> , 0 0 0
<br /> Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST. .1 ...0 4, and available options. -;:ia; To
<br /> , . ...÷ .4. • _, $ 7 5, ooc
<br /> (Please round to nearest dollar) do+ /
<br /> 1419 /e
<br /> 1 The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des No Don't know
<br /> _
<br /> 2 Is there a wetland or floodplain on or near the nroperty2 EYes 111,4 No ElDorit know
<br /> 3 Have you talked with the township about your project and are they in agreement? „ EYes No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years?, .......... [E'res riNo
<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) DYes No FDon't know
<br /> 7 Is this to correct a violation Tr es No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -+ -+ --■
<br />
|