Laserfiche WebLink
. '---7 _..3 4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �� l <br /> KU( Ta,�c,�n L►eva.v . Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 5 y,(0 an id n a Bo n;e4 w ` 5354 0 Deed Restriction; CSM <br /> J�tl 1� Variance(# ) <br /> OME PHONE CELL PHONE E-MAIL A DRESS <br /> 0 • -CO ., . &ta-77-54 knsken • @ 0 n'ict-d(.LV VY1 ■ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION .nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS r o ell/septic <br /> (City,State,Zip) (City,State,Zip) ,�J wetbacks <br /> PHONE PHONE ite Plan approval from <br /> a licable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> • ••r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) �•� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> PARCEL OS5 __112- o ,0 -g N ^1 q rontage drawn to scale. <br /> NUMBER IJVID 2. <br /> TOWNSHIP: SECTION: <br /> BActck iw( 2 l 1/4: NW 1/41/4:_i4 E. Drive ermits <br /> s ,c n ,town <br /> ADDRESS: �,- ,, 1 \ ( � ) <br /> 5tIND r '�' `� mac` Sanitary mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT te) <br /> ti:- Lb 1 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> beck ' 'l-\') )- -fig` > > " --mooning District <br /> This project is a new building or structure. <br /> ermitted Use <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ura °° _° s <br /> ❑SEWER SEPTIC (ne - 'sting'* <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2 1 etl• _r • lain/ <br /> AREA TO NEAREST SQUARE FOOT: ' (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST F R: Erosi= w' [• permit <br /> �_ + TOTAL SQUARE FOOTAGE: 4 (slopes 4lt7ance, <br /> i(ii .,.cce ) " <br /> 2ND FLOOR: 3RD FLOOR: I Z <br /> ESTIMATED CONSTRUCTION COST: ?`- @VIEW "- on Survey <br /> (Please round to nearest dollar) <br /> -► -► -. -► r)� and ava options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 11,2iNo Cl 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'? lZIYes 0 N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes to <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 o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> (APContinue oPLICATIOn N Back)MUST BE SIGNED <br /> 545-112(4109) <br />