Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME (14-/L 1`?�� CaQ,.).arm n \ Sci$4-2 Le. city , Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7876 /( -c IpE3 SimCr"z t—,L Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ' - 6'13- `_ 96 3—5-57 Li Ku .,, ced,(f...0t.5 if-E.-We. i e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE... NAME IC C NTRACTOR NAME <br /> /jf f /6f1C (.tl LlicS s yOtc..4 7? <br /> ot_. ElySiterAan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /217 c0.t-Frre-R(Ai r05- 5"*WC" <br /> (City,State,Zip) (City,State,Zip) acks <br /> 412fE 00 5A- Le■ ' 575—'7e, .SI*ua <br /> PHONE PHONE Site proval from <br /> (��Z.4f3--1 f 32 6 Si, c, appl' township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .11#e � 5 C 54 , • 5 oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El at ion Of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p <br /> PARCEL ntage drawn to scale. <br /> ❑NUMBER (/`)0-7 °6 J q c a(' 7 ('— f G';S i 3 -- <br /> SECTION: <br /> 0 Y.: +/4+/4: ❑Drive' rmits <br /> ADDRESS: / / <br /> 6 S- (St nty,town) <br /> / U ❑Sanita* .-rmits <br /> CSM: Y V SUBDIVISION BLOCK/LOT <br /> PROPOSED PROJECT INFORMATION ST FF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5Y4414 14 4 O I`[teW 'To G/LOV 114..'55 Jz t7 nin istrict <br /> . ❑This project is a new building or structure. P fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (ne <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 etla /Flo lain/ <br /> AREA TO NEAREST SQUARE FOOT: Or @la attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST F OOR: ErosionControl permit <br /> 01 s x 2! + TOTAL SQUARE FOOTAGE: + (slopes,disturbance;— <br /> 0000���� filling/access) ■ <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3 12 Etja view Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available optio . Cow <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 1 0 0 J< <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ao ['Don't knolk <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Rio ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? res ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes ao <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 Jlo ❑Don't know <br /> 7. Is this to correct a violation? [Yes 0,10 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -► <br /> 545-112(4/08) <br />