Laserfiche WebLink
At_i 8 ifo <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME , <br /> G-�Yt��S. aN't IV�zr-ti i'V,, Je_f a , ❑Zoning t ,CUP; <br /> OWNERADDREt;S (Number,Sleet,City.State, ) J, ' ' ii Deed R ction;CSM <br /> qv 4 4 Far \i; uO (1A MA-le E i \V i 5 35 t,c, Variance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (00S-r1 ag-OS(o5 C7 e_ a. . c L • S_ Not ❑Site Pla d to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and indu s n dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (1,10/k-1 -- N c jJ E ❑Site Plan incliKocation <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑SetbvKS <br /> PHONE PHONE ❑Site rla 4• •val from <br /> appl'►.•1:It. nship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ,FI plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ID lev On Of property <br /> ElNUMBER PARCEL NUMBER: p CURRENT ZONING: ACREAGE:PARCEL <br /> NUMBER U o 7-i i i 8 l oo 4 A-1 ex 11 .700 ge drawn to scale. <br /> TOWNSHIP: • <br /> {�j SECTION: ,/l <br /> eLY-r 17-8 -7 v: 1/4'/4: /\C A ❑Drivew,� 1111 <br /> ADDRESS: `f (state, • ai,town) <br /> q 044 Fad V tee W Aa ww?n 1e V�Z '� 35(00 ❑Sa 'PI AriT!its <br /> CSM: LOT ' SUBDIVISION BLOCK/LOT (pu r ate) <br /> — <br /> PROPOSED PROJECT INFORMATION STAFF VIEW <br /> PROJECT DESCRIPTION: <br /> 540rd5P �Yl ❑ Zoning ' trict <br /> . <br /> This project is a new building or structure. ❑ Permi�tgdI Use? <br /> This project is an addition/alteration to an existing building or structure. VV <br /> SANITARY SE CE: PERMIT NUMBER: ❑ Rural Address <br /> EWER REPTIC (new/exist tq) <br /> HEIGHT IN FEET: �/ �� 1 NUMBER OF STORIES: (Not induding basement) �J <br /> 465". 12-/ ` 7� / 1Vt Z- U n� Cl Wetla • Adplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shor I. .:chment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ Erosion •%trot permit <br /> '9 SF ,,. TOTAL SQUARE FOOTAGE: ,, (slo d'= T'•ante, <br /> 2ND FLOOR: 3RD FLOOR: fillln /a C'SS) <br /> 9a 5F ❑ Review LLLnnn�•lkonSurvey <br /> ESTIMATED CONSTRUCTION COST: -�► -► -�► --► -► O and a 10ir=1•• ons. <br /> (Please round to nearest dollar) ! 3L y v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes llo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes ill o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes A o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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) Oyes �lo ODon't know <br /> 7. Is this to correct a violation? ❑Yes Dslo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -► <br /> 545-112(4106) <br />