|
SUPPLEMENT to Web-App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWER NAME r 2Akk, n�e��e,WS`'
<br /> '1 1' +G ❑Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) , 1311- 1`,.-11.1-4-'3 yZd.)Z14-c-)-E•r,,F Deed Restriction;CSM
<br /> 8' '� lc, 1 - - - - - , .. . l•rt,C--)315- Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> 608-- L
<br /> )-5--q11, :Q;A.r,Iti..2 JSki I - w"-a;\ CO"_ ❑Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION;.., and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 1412. A S f p►. ?-64.1. c,?-64.1. c, ❑Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> 700 ' o-3.c j r., *313 790 12.0,4-c Or.;V'S/3 •
<br /> (City,State,Zip) (City,State,Zip) ❑Setbacks
<br /> ii/AA 406 /01 )1 ✓naAi`So11 POi X371)
<br /> PHONE PHONE ❑Site Plan approval from
<br /> 60y,-3S H&3$ 60k-.2.2 --50 ,‘-1 applicable township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> •ue 09a.r4.',sulk,k 4"itkS;dj11.c0.,., , ti.(i)cAr4 kap dca1u+..41/25 v,.cD,,,,, El Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (httpa/accessdan' e.co.dane.wi.us/ ❑Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> PARCEL ) ,-5, frontage drawn to scale.
<br /> ❑NUMBER ��/U607�1�11-41yN-� ��� ��
<br /> TOWNSHIP: SECTION:
<br /> i r,� tci /: %4%4: ❑Driveway permits
<br /> ADDRESS: 1 (state,county,town)
<br /> >.,K txrk'' Rd. , � E0i1k ,Lt �3& 1 h ❑Sanitary permits
<br /> CSM: L' SUBDIVISION BLOCK/LOT
<br /> ci 79) 3 (public,private)
<br /> PROPOSED PROJECT INFORMATION _STAFF_REVIEW
<br /> PROJECT DESCRIPTION:
<br /> SLAttt Yttj•/ de`k ❑ Zoning District
<br /> This project is a new building or structure. Permitted Use?
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ® Rurl Address -
<br /> f)EWER IEPTIC (new/existing)
<br /> HEIGHT I`FEET: NUMBER OF STORIES: (Not including basement)
<br /> /d ❑ Wetland/Floodplain/
<br /> Sreland_(attach
<br /> lio ment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> t=:_. EroionControl permit
<br /> BASEMENT: 1ST FLOOR: s
<br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,Calsturbance
<br /> filling/access)
<br /> 2ND FLOOR: 3RD FLOOR: #
<br /> 44 V ❑ Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: �� �� and available options -
<br /> (Please round to nearest dollar) --►
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? lilies rlo ['Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tNo ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ErNo
<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 "lo ['Don't know
<br /> 7. Is this to correct a violation? :Yes Elio
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) —► —► —►
<br /> 545-112(4/08)
<br />
|