Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> I�t) I)et$ a` V T end , e r ifV c /kLi k ❑Zoning tus;C ; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Res 'ctio ,CSM <br /> 6 /b S'J u er� C i,c��2 1.5 c e VT 0�6,y( variance(# ) <br /> HOME PHONE CELL PHONE i E-MAIL ADDRESS <br /> ❑Site Plan drwnio scale <br /> AGENT INFORMATION i CONTRACTOR INFORMATION and includeO6ensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cvs4ow%L._onsit uci',o-g v'hers Tv,c ,sa I,,n e ck S c 3r,,,-t ❑Site PI including location <br /> AGENT ADDRESS n CONTRACTOR ADDRESS of wells pt c <br /> 0Ocj is,,,c u,0.4 Pa SS ��__ <br /> (City,State,Zip) (City,State,Zip) ❑Setbki <br /> Cro ss- P1o1 w' c S3 S D 8 <br /> PHONE � PHONE ❑Site Pla .pp • ".�!608- 79g - 4A3y5 ': t• <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> GS 1-rnL0MS d4 d- orUS , rl of ❑Floor plans t s le <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) ❑Elevation Of p party <br /> PARENT PARCEL NUMBER:C/ CURRENT ZONING: • ACREAGE: <br /> ❑NUMBER 0 i I J (., { 7'S�0 Re-c e„L, ,, I i J l5 Q.C rPs frontage d n to scale. <br /> TOWNSHIP: (/_ SECTION: ��(�J <br /> i+A e \ .('o V e 9�6 %4. 11 '/4'%: ❑DrtVd��rmtts <br /> 6. <br /> ADDRESS: S (state, nty,town) <br /> 4 OfI'3 S h t-S'ti A c l e 4 R o C.1 3`--E-9.O 1f i 4 41)P-411 <br /> sanitary perm <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> II‘70 3 <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REV IEW <br /> PROJECT DESCRIPTION: <br /> New ro i(_-- I3 e ❑ Zoning Wrict <br /> . <br /> This project is a new building or structure. <br /> ❑ Permitt ? <br /> ❑This project is an additioNalteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R _I Address <br /> EWER �EPTIC 13— J017-00060 /existing) <br /> HEIGHT IN FEET 1✓ NUMBER OF STORIES: (Not Inducting basement) <br /> i i <br /> Sh (- 't: hment) <br /> AREA TO NEAREST SQUARE FOOT: b(eland <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Ero nC•r,y I •-rmit <br /> BASEMENT: 1ST FLOOR: ,/ <br /> Zan , v '1E16 V ,`. TOTAL SQUARE FOOTAGE: j (SI••_- d= • •ance, <br /> fillip• access) <br /> 2ND FLOOR: 3RD FLOOR: g� <br /> ❑ Revie L•i,�•-1 - ey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ - ♦ ♦ and -r-= :i e o• ions. <br /> (Please round to nearest dollar) $ 4/7ti 6 a y <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 er . ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ■ • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes )Jo <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 'lo ❑Don't know <br /> 7. Is this to correct a violation? [Yes [ No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 > (Continue on Back) -► ■ -6. <br />