Laserfiche WebLink
, LI 69i1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> A Re t,N -4 pA i k%c.l A Li 00 4 t-&2 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1 P.o. Ls 4 D6C.R-F'i 6t-0 or. S 3 S 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4e% _235-910'$ ' -FiJil.E.LiAJtkik L A. . c t.A Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S 4-1-10‘tT/ Sc it.Ai u(r -1 b ,1&'J 1i t Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 316 KJ . 4T Loc-LO L-k) <br /> V(City,State,Zip) (City,State,Zip) 'Setbacks <br /> DE 2f1E.LL� ) t�.J.:. S" 3S3I <br /> PHONE PHONE -4 Site P n approval from <br /> C%-.- 2(S-72--7‘ app cable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Sc,li t Tr ti-�DLS L A r+u% ca,'• <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: G n CURRENT 7ONI G: ACREAGE: ❑ Elevation of property <br /> ❑ <br /> NUMBER C�E't--)-l a-O OCS-O R —� 2- I Z`� fronts a dra ` • scale. <br /> TOWNSHIP: SECTION: -1-.6‘.1) f..Ile <br /> C IAR 1(,T l AT)A -NE Y4: iv tA./ '/a'/a: Z I LI Driveway per ' jQ <br /> (state,count town. <br /> ADDRESS: y )l <br /> K. o,5L(gyp A„f, Pci F : itary permits <br /> CSM: LOT S[7BDP SIGN BLOCK/LOT •Ubll • J <br /> i2.104 r � <br /> PROPOSED PROJECT INFORMATION _ / <br /> STAFF 1 1l d <br /> PROJECT DESCRIPTION: /' <br /> 1\4,11.-) I+UM c s fl \,-1/De ,42 <br /> onirtig District <br /> . Gi This project is a new building or structure. Ilk .:� ' ,$ -? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ERMITNUMBE-1 0 RUraiAd(t!r: <br /> ❑SEWER [.SEPTIC 6-+4T Xi ng)- vilrp <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Wetl toodplatn/ <br /> S nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: I•ft <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) /t� <br /> BASE ENT. C 1ST FLOOR: t^rOSfdnCOntrOl permit �(y/ <br /> j TOTAL SQUARE FOOTAGE: , (slopes,disturbance, -F`3 <br /> 3 S3 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: S S <br /> f, Review L tam Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -�► ♦ ♦ ♦ $ 3 v j CVO• C11' cJ 8V ble 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? ❑Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes in 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? Cl Yes ai 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 Li No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► —► <br /> 545112(4/08) <br />