Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to 1Aleb App:#' <br /> iROPERr O WNER INFORMATION;. . � ,. A` r ,4`a,_ .`� CUSTOMER TO O PROVIDE <br /> OWNER NAME // ,,,/ �/ r <br /> I� " 4/►1 UV K -, s - ❑Zoning Status; CUP; <br /> OWNERADD ESS (Number,Street,City,,State,Zip) /,/ _ Deed Restriction; CSM <br /> u-0L4 ,9/ict° /grit/L/7. dr Dip/n GUl ..35 75 Variance(# ) <br /> HOME PHONE CELL PHddONNNE E-MAIL E l <br /> /; LZQ 7fi3O / i+e/cer- ft,7 7Ar / , 4-"Li Site Plan drawn to scale <br /> AGENT`1NFORMATION '; ,, CONTRACTOR INFORMATION` t;t ;' and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ; ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,Stale,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> ❑Floor plans to scale <br /> :PROPERTY/LOCATION!' INFORMATION '(tittp//accessdane Co:dane wi us1) 'y <br /> PARENT PARCE NUMBER: 213 CURRENT ZONING: ACREAGE: . ❑Elevation of property <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER D2 SjOG/0 X81-701-Z � g <br /> TOWNSHIP: SECTION: <br /> 5 <br /> wA( SE M/: N4 %4%: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 242-9 4/, e Pain/44 Or ,000/1 !A// 53s7c- <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> /g /4// f;10:9,4 le .✓ (public,private) <br /> PROPOSED PROJECT INFORMATION ,. STAFF REVIEW <br /> PROJECT DESCRIPTION: /, /f ^ <br /> FriV - ba gX f Zoning District <br /> 1 7ti.< <br /> . ❑This project is a new building or structure. Y �. ' <br /> '� Permitfect Uses i :. <br /> []This project is an addition/alteration to an existing building or structure. = lI `: �- .� <br /> SANITARY SERVICE: PERMIT NUMBER: .® Kral Add reSS i <br /> EWER RPTIC (new/exlstmg) _ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 1 Fpp fi ❑ Wetland/Fiood platn/ <br /> = Shoreland (attachment) rt, <br /> AREA TO NEAREST SQUARE FOOT ot� <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) : --� '- - <br /> ® ErosionControi prmit <br /> BASEMENT: 1ST FLOOR: �SOpe aii.turba <br /> nr cv'e <br /> 4, TOTAL SQUARE FOOTAGE: 4, , <br /> le 50111.�acces K <br /> 2ND FLOOR: 3RD FLOOR: cart" <br /> ,(�y �z t <br /> la Reviewocatio S 0.0- <br /> ' '` r ESTIMATED CONSTRUCTION COST: and avalble option <br /> s <br /> (Please round to nearest dollar) --∎ -0. -II. -I. -0. --10. ��oo,0� :, aF:r'+ <br /> ; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes E Jo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ao <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) [Yes ffiNo ❑Don't know <br /> 7. Is this to correct a violation? Dyes [ to <br /> APPLT B <br /> (Continue ICATION on BacMUSk) -►E SIGNED♦ -► <br /> 545-112(4/08) - - <br />