Laserfiche WebLink
FSUP.PLEMENT li YY_eb APA <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PRDPERTYONINERC INFORMATION' - . -'x -11-•''-; CUSTOMER TO PROVIDE <br /> OWNER NAME 6---- / <br /> l l 1'Vl �JLA I �.e� Zoning Status; UP. •.6. it <br /> OWNERADDRESS (Number,Street,City,State,Zip) 1 WO n keel ' 11( Ur / <br /> VSS ,Sc_ht,�m�0-her Qs-1 . C W Deed Restriction;CSM <br /> ME PHONE ELL PHONE E-MAIL ADDRESS 5G'�! ,`/ Variance(# ) z ii <br /> (0D8)575-39 -I fl(YI(L�(,l-j jc�-rC'h l ,C(Yr) 5-A Site Plan drawn to scale . <br /> •AGENT:7NFORMATION, _' '.'1.-%'7:.:'.' 1_CONTRACTOWINFORMATII0 CASAWL and includes dimensions g?1 <br /> 'AGENT . _ Tr- . jR NA �f <br /> (. I I .-... RI <br /> (Site Plan including location ' <br /> AGENT ADIRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) NrSetbacks 6 00 <br /> PHONE PHONE Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS • �� <br /> MI Floor plans to scale <br /> Ai <br /> 'P..ROP_ERTY/L"OC ATION INFORMATION htt //accessdane eo lone wi uis m <br /> PARENT 'ARCEL NUMBER: CURB ZONING: ACREAGE ❑Elevation of property <br /> PARCEL �J �y �j • • tage drawn to scale. <br /> ❑NUMBER 4,qP 337 t 7,,0o0 cs— I / <br /> TOWNSHIP: J `` C.1 sEC�I 1 //��/! W % S r "Driveway permit - <br /> • <br /> tv/ 1 e "1 _S �4. / �4�4. <br /> ADDRESS: (state,county, • j <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, - <br /> 3 �`� ^� (public, <br /> • <br /> PROPOSED PROJECT INFORMATION `',' STAFF REVIEW { <br /> P EC DESCRI Q 4.7..,:e: r ( ' za 41.F i,* ,,,i<'+ 14 —/ <br /> E v- rh2 Gt 0°°K.9 e x Y o x 16 , 14.14_ 1, <br /> GP v"4 1/ ;)g4 oning Dlsfnct�# 2 <br /> This project is;ul l�:lfit•i.•r structure. o I-Ne -1-0 ,0. perfnitfOd Use?, Ti} 5 <br /> ❑This project is an addition/alteration to an existing building or structure..' g �p tl" , J <br /> SANITARY SERVICE: PERMIT NUMBER Rural A•• �, t .: <br /> EWER JXEPTIC ,` — , t - <br /> HEIGHT IN FEET , t NUMBER OF STORIES: (Not including basement) '4 .+F ,s r= .,' ?��.t <br /> t _ x <br /> 4 j �-.mho elan•E("a�ta`chment).-= i <br /> AREA TO NEAREST SQUARE FOOT - '' '. ':- t7=-'.- • <br /> (Outside dimensio including unfinished area attached garages and above grade decks or porches - <br /> ® Erosion s ontr. permit's <br /> BASEMENT 1ST FLOOR f\ 0 4,TOTAL SQUARE FOOTAGE 5 pes dirt r:a Ce -4 `:, <br /> - filfin cress .} ; <br /> 2ND FLOOR: 3RD FLOOR .3 6 0 d 's 4 „�r g . <br /> _ ivsy e�ni�Locafion-Survey //' <br /> ESTIMATED CONSTRUCTION COST: $ A �fo o ; z_ nda a7�bl:`e options':: /LL <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ '♦ ♦ $ V� U 6 d D ,T x;__;,= '�+' =- } -X; `. f'T <br /> - 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ❑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 ❑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) DYes ❑No ❑Don't know <br /> 7. Is this to correct a violation?- ❑Yes ❑No <br /> r APPLICATION MUST BE SIGNED <br /> X 3 0 (Continue on Back) -► -► -► <br /> 54.5-112(4109) . <br /> 'Th-7/—(77 --t/I /1°K'''(12 , <br />