Laserfiche WebLink
' za 42.4?a <br /> , . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME • <br /> T oA ?e 01 .) 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 86 73 /41 Z. Paarr 1244 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS _,/ <br /> 821_ �.3R4 IJ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON?T',��CTOR NAME <br /> leak) bill el e, . NIC.IQS. INL 0 Site Plan including location <br /> AGENT 3 CONTRACTOR ADDRESS 7#4.-rd- 7 �/of well/septic <br /> 15-21- 517+16" <br /> (City,State,Zip) (City,State,Zip) L� Setbacks <br /> &Ace. e-T!4- Gut .S. .ctr <br /> PHONE PHONE Site Plan approval from <br /> Epp S-7(7- 27aq applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> G—�4s Ja' '2S �pyy/ door plans to scale <br /> • <br /> PROPERTY/LOCATION INFORMATION (http:Ilaccessdane co.dane.wf.us!) �, ,� <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: J'Elevatron of property <br /> Li PARCEL O1007o70/I/COos II-/ ?S frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> e12055 LAI S SLR IA. N cc..i %1/4; ❑ Driveway permits <br /> ADDRESS: - (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION S' A 1F REVIEW <br /> PROJECT DESCRIPTION: <br /> M4C14/Oa!!°- ad/A-0/61Z .t'S ' LI Zoning Ristribt . <br /> 'a,This project is a new building or structure. <br /> - l meant(mr l:se? <br /> O This project is an addition/alteration to an existing building or structure. `b <br /> SANITARY SERVICE: PERMIT NUMBER: U I uralAddress.. <br /> C3 SEWER CI SEP'nC i)04/4 (new/existing) - <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1- arg• .6 .10.6bdplatnt. <br /> Shoreland(attaEllrnent) V <br /> AREA TO NEAREST SQUARE FOOT ▪ -_ _ - _ _ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> �I ErQ tdCl t lrof p rmit <br /> Z 6� 4,TOTAL SQUARE FOOTAGE: , (slopes,.disturbance, <br /> 2ND FLOOR: 3RD FLOOR: — fillln aECess <br /> U::-=R6rekrifialkirl Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ _I. 4. ♦ -aniavailabfe 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 O.No Q Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? M Yes U No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? U Yes 21No <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) 21 Yes ❑No 0 Don't know <br /> 7. Is this to correct a violation? 0 Yes 0 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -4. <br /> 545-112(4109) <br />