Laserfiche WebLink
• <br /> o' _ rasz "%I Lp� `Ro.+caoe <br /> .t 9.. Z,1•lR NA tm 4 e^cL <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> . , . <br /> PROPERTY OWNER.:INFORMATION 4i.::;' ,. z=: - '1, 00 .-=, ''< .,:')t_2{ CUSTOMER TO PROVIDE <br /> OWN�R NAME p <br /> ,A/j A Al /i;B 6e-A • £ <br /> �� Zoning Status;7 ❑ Zonin Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction;CSM <br /> /2 `�� �;�yt 4, "41/-140(..— ki-r- Variance(# ) <br /> HOME PHONE C PHONE E-MAIL ADDRESS <br /> her a 03- 60 I-2-- I Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR;;INFORMATION'::= %; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> &•idN/S /4vrz . 4 y 71-k vst.� Q.//ee' S .4g-e _ a Site Plan including location <br /> AGENT ADDRESS / CONTRACTOR ADDRESS of well/septic <br /> Rio4 '-G7�C� 3 //O 644'Lh S--f. S'c',f / • <br /> (City,State,Zip) (City,State,Zip) 3 Setbacks <br /> amp%, .6_ ii z . 5-3 s"9 7 (*£ Air 5--15-- 7 <br /> PHONE PHONE 3 Site Plan approval from <br /> y1,6K,/ Fy' y 3 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS . ',1J5-- 4-14v,/arl 5 67-19t.�.. <br /> ff ,v5'S-^'go/I 4) 7-5-..A/6 T ._ 1 Floor plans to scale <br /> PROPERTY/LOCATION'INFORMATION (http://accessdane.co.dane.wi.usa . Elevation of <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> P rtY <br /> ❑ PARCEL 7g�U frontage drawn to scale. <br /> NUMBER 6�'0�3f� y �\ 1 Z3�Z Y� se <br /> TOWNSHIP: '`�'J SECTION:i5 -/ 7 Driveway S/°2,, ç,f /(�' L %: AI '/'/4: y permits <br /> ADDRESS: (state,county,town) <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION. ' - `ice .� <br /> PROJECT DESCRIPTION: -." ' <br /> 5‘41.5/L An-I, 1r Kf5/hNciC- :en s w W , <br /> JO This project is a new building or structure. Os -r a <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 6),11,11. ,;46T'p <br /> ❑SEWER 0 SEPTIC 57r/13 �i )o 3 <br /> HEIGHT IN FEET r / NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: ` ..t,IA1-1 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - " <br /> k 0 �a <br /> BASEMENT: 1ST FLOOR: ,- ' e . s ,� <br /> / / �� �, TOTAL SQUARE FOOTAGE: 1 y,g ' fi 1' <br /> l� • 141 } <br /> 2ND FLOOR: 3RD FLOOR: �� � <br /> ' z6 / ,165---- <br /> ESTIMATED CONSTRUCTION COST: " ��� � �� 2 <br /> —► —► --► —► -► a P21,�asrp = � <br /> (Please round to nearest dollar) � a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EI.No ❑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? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 21 No <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? LI Yes q No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —1 —► <br /> 545-112(4/05) <br />