Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER•NAME <br /> PPUI. A I.gQgVJ gOJiuea ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> I Da Gornml,ni ii Or FAIU.IZuw2, w c 539 3"1 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AD RESS <br /> I'%()-ye- 34S'(. I-$16-37s'-oa61 yuungtmil l@ Gail' ' 0.1.rx.4- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> APOZON 130414 IS 04) 14,41400 gtllt.OiNlai TRIM L.R.L. LI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7441 West-LA-14u az. Po 13ox 53 tut <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> CO1TPtiAC t lave t4 55S1 CarrAc.c elude AAA. 5.35- --7 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (,O - 43•(/ t.? L,00S.1(43-(0'iV3 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ao-harri4on Q u4 wii'tort -har'ri ri ho m_ I.[u ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER O)a.I O4 I I 't�3't{OSS•c AC I .75.°) <br /> TOWNSHIP: SECTION: <br /> TOWN of (3g0 Tu., i t '/a: J w '/a'/a: Sk,..) ❑ Driveway permits <br /> ADDRESS: '7/s-7 ?F I L t✓1 LI (state,county,town) <br /> L° `} ( Sanitary permits <br /> CSM: LOT SUBDIVISION / LOCK/LOT (public,private) <br /> Win FlSDEbt til peal. <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ,SIn9e, ram ii Nao k60.- COnSATVIAlor X. LI Zoning District <br /> X This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ASEPTIC 3-1 V b-7' . (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 311 U4 10 PEAL F 12o0 F 'Two ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I—, ErosionControl permit <br /> 19 30 i4-�c, 3)O 1 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> I� filling/access) <br /> 2ND FLOOR: 90 3RD FLOOR: (,,(-115 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: QQ and available options. <br /> (Please round to nearest dollar) -1. ♦ ♦ -�► ♦ ♦ $ 3 55,ot�v p <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 ❑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 12i 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) I )Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes kI No <br /> r APPLICATION MUST BE SIGNED <br /> 11°I (Continue on Back) <br /> 0 c 64 <br /> 545-112(4/08) <br />