Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ,6e#101.5 1/ &yri-ii ./Y/►LC Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> , ) Deed Restriction; CSM <br /> ' 2(0 I lags I C..0 '°s vee., / U//. 2.7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 657 W0 'i' X US's" il ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> K Site Plan including location <br /> AGENT ADDRESS CONTRACTOR RESS of well/septic <br /> (City,State,Zip) -5 (City,State Setbacks <br /> PHONE . PHONE It� approval from <br /> p Icab township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> .Floor p to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) Elevation of o P e <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: rty <br /> Li PARCEL G/g/O7//-2/2- 95 /� q ..1 3.z, frontage wn to scale. <br /> NUMBER 'L /�- �'7 <br /> TOWNSHIP: SECTION: <br /> Co� &oYc- CO 2.i 1%. N 141%: ,SGf) Drivew ermits <br /> state o ty,town) <br /> ADDRESS: 'a c <br /> 8 41a� e, 6-e, 1 °'ss2:7 Sanita , ••rmits <br /> CSM: LOT SUBDIVIS`ON BLOCK/LOT <br /> 011702- ¢ (publi ;l;vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: '.=-i r"A. 4 '3 ��1 <br /> "4 J Oning District <br /> ) <br /> AThis project is a new building or structure. Lac Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NU B Ural Address <br /> ❑SEWER EPTIC J d 7 (ne Irl j <br /> HEIGHT IN FEET: / NUMBER OF TORIES: (Not including basement) c" <br /> /5 )e- / WenanwRoattach / <br /> horelaayatt hment.) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> E •°nCon s permit <br /> „ f1 Q j TOTAL SQUARE FOOTAGE: ,`, (slopes, 1.i... s-ace, <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: Review L+- t Survey <br /> (Please round to nearest dollar) ♦ ♦ ♦ "0, -�► -� $ 2U) OCO, and avail- •phans. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CI Yes la No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes el-No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes c1Vo <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 aisio ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />