Laserfiche WebLink
. APPil 3L{ S 1 GizoSip/.i 'c:o.,JTraoL <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,( � <br /> an a rpc-v�\y <br /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> t loo ... Vero,1q A . Ue,ro-A WI .S 33-'1 3 <br /> / / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> flit.Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA 1E CONTRACTOR NAME <br /> ( 061-4-IN <br /> p1'l� s ..o^S Ltx1 �Ince Cara f ct-1je <br /> 1 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES n of well/septic <br /> Sa t 701' �. t..tias ,�i -N (/eve. <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> +,xh,).:fo,. , U13- 5 3703 <br /> PHONE PHON ❑ Site Plan approval from <br /> 2S 7.050 U applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> � <br /> LI 1,,c Q('o 6 er-€C..zS-►i..•c+•,' t^c. .'. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: TTT��� p t rtY <br /> ❑ PARCEL ^ frontage drawn to scale. <br /> NUMBER O(co1 -I yZ-96CZ-O A-ley. <br /> TOWNSHIP: SECTION; <br /> 1/a: <br /> 141/4: 1:1 Driveway permits <br /> ADDRESS: (state,county,town) <br /> t t" E. V.erro -‹ , v-c i„.:ti Li)-- 5 3 3 S� <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> it)0.ay er PC / e IN`°. 11' eNf e.eA...cr ❑ Zoning District <br /> ZINThis project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERV CE: PERMIT NUMBER: ❑ Rural Address <br /> -SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER CF STORIES: (Not including basement) <br /> 12 e a-t 1 ❑ Wetland/Rood ain/ <br /> Shoreland.(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gal'ages and above grade decks or porches) la <br /> BASEMENT: 1ST FLOOR: lCtfrltrClr!'1Ut <br /> TOTAL SQUARE FOOTAGE: (slopes,.disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 117, 3o0 S r- <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> and available opt ions. <br /> 10 -10 -10 -10 -10 -0. l g/oo 71 O .�O(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 4E1 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? la Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes igNo <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 ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes 1No <br /> APPLIC(Continue ATI on Back)ON MUST BE SIGNED <br /> 545-112(4108) <br /> -► <br />