Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> not ' \ 3't bcmt Z.Zoning Status;CUP; ' V /' <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1G1L1 "bvala,o 12-coca ) - .Y-601( ∎n (-'0\ S3 S 011 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6208-5►to-lLio9- ,•: - at1--)ort3 • nrIct-tf byicolor, (om <br /> Z.Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions /Qp <br /> AGENT NAME CONTRACTOR NAME <br /> Site ' - • ••ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/septic ` <br /> (City,State,Zip) (City,State,Zip) / Setbacks '3/ 3� � -0 <br /> PHONE PHONE rnite Plan approval from t `q- <br /> a•._..=-unaa• - •••. �"I .I <br /> E-MAIL ADDRESS E-MAIL ADDRESS /I ae <br /> A Floor plans to scale + , / <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) VV!�) <br /> ❑ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levatlon of property <br /> NUMBER OW)30.191 Ca 5a N-1 (Ex) 9,50 8 frontage drawn to scale. <br /> TOWNSHIP: SECTION: �'' <br /> 'V)u kanct 3 2- '/a: N 1C i,,ya: 5 L✓ ,I=� Driveway permit <br /> (� '/` ` "S'2 (state,county, • <br /> ADDRESS:, IL\',,`lc��C3Qd, M�(�(-1 u3\ JS C7,■ <br /> CSM: t LOT SUBDIVISION BLOCK/LOT ❑Sanitary p-_��•its <br /> i \3 I (public, . <br /> PROPOSED PROJECT INFORMATION g STAFF REVIEW max: <br /> PROJECT DESCRIPTION: } t <br /> '--Pt5ke ),,,cf 6 6 / (X / 3 ` it b n• Dist` � <br /> . ®This project is a new building or structure. "ePcd a t • '`7 4 Y<< ;' ri to I r <br /> ❑This project is an addition/alteration to an existing building or structure. �_ ` ' <br /> �. ' , e th. <br /> SANITARY SERVICE: PERMIT NUMBER: F j••Ii -• <br /> EWER PEPTIC XlStln• 1/� 1 <br /> HEIGHT IN FEET r N `- NUMBER OF STORIES: (Not including basement) f fr' rc' i it 4/ <br /> 1 W Vi Skin((9Ylt _ = 100(� t : <br /> me0t a <br /> AREA TO NEAREST SQUARE FOOT: �' mot)LL 4//00 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or ••rches) ..' . <br /> BASEMENT: 1ST FLOOR: q ® r0510nC0 trOI p l7ttlt ®9 <br /> © 1I + TOTAL SQUARE FOO GE: , . (s10•es,disturbs Cel 9 r/` <br /> ' cc ss) /j <br /> 2ND FLOOR: 3RD FLOOR: • '.. ! <br /> 0 O 9 I lao ��, / <br /> C3 Review Lbcatio)'t survey : <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available optio s <br /> (Please round to nearest dollar) 8 1 600 k.. , y . _ , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes alo ❑Don't know .9 f/( <br /> 2. Is there a wetland or floodplain on or near the property? ®Yes 'lo ❑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 [• 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 �Jo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes EINo <br /> CS l:( Z-1/3 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> F(00br. <br /> (Continue on Back) -� -► <br /> Fie %./ r 1 0 'k 5 <br />