Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS NAME Pal h Le, and_ e Pajr(tel __.. ..- - ['Zoning Status;CUP; <br /> OWNER RESS (Number,Street,City,::Vt e,Zip) C-• L.. Deed Restriction;CSM <br /> I(aQ.o ent .l t Pd-T mcLr,shall_ _ .53 53-- Variance(# ) <br /> HOME PHONE j CEL PHONE E-MAIL ADDRESS <br /> la°S-S' 11.-'5 1 1°C'5`22573527 LE Fe act_ l I @ #rout 1-Con-A O Site Plan drawn to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C- <br /> - ns Lea d L� Ec 9 e e . 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR AD ESS of well/septic <br /> in e O s h c ,ti se, bCv-C.- <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE — PHONE ❑Site Plan approval from <br /> ,s c1nn e, applicable township. <br /> E-MAIL ADDRESS E-MAIL <br /> S C ,ADDRESS <br /> \ )(I 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accos dane.eo.dane.whus!) Elevation of property <br /> PARENT PARCEL ZONING:CURRENT ACREAGE: frontage drawn t0 scale. <br /> 0 NUMBER G S/(-13�-._ 'o (> ,e. �l - r ( <br /> TOWNSHIP. <br /> y }` f r/ SECTION: r - Driveway permits <br /> Tow1 ) Cr i 1 ro t i c 13 1/4: sW 1�41�4: <br /> (state,county,town) <br /> ADDRESS: _ �^� <br /> IL �tL 3ounlZi 41 i�c �y ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1255 (public,private) <br /> I <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Fen.Ce, I ns�Ctt( ft C>f u..)/ (.3 CI 1 c ❑ Zoning District <br /> Ea This project is a new building or structure. ❑ Permitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE EWER EPTIC PERMIT NUMBER: 0 Rural Address <br /> (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> var L€S -S e c, . i t on !5 `�{S 2 ❑ Wetland/Floodplain! <br /> > t Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: 3 TOTAL SQUARE FOOTAGE: 3 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: ,---i (0 z cX S <br /> ) ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q �t/y and available.options. <br /> (Please round to nearest dollar) $ Lp 1 t-jl.(,-) ` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes , to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? OYes 'r o ODon't know , <br /> 3. Have you talked with the township about your project and are they in agreement? es U opef rnt±pencitilcA f <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ONo ZOnLin Ci,WI CVO-1 <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 `emu o ['Don't know <br /> 7. Is this to correct a violation? Oyes r o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />