Laserfiche WebLink
MO' eFF 1+° <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> OWNER ADDRESS (N Street,City,State,Zip) <br /> ❑Zoning Statu CUP; <br /> (9q4 4 tS' ��� CIL r_ '� % wr SSG94 Deed R stri ion;CSM <br /> C�"� W Variance ) <br /> HOME PHONE ,�,a CELL PHONE E-MAIL ADDRESS <br /> ..: gLAO'" ,TT►1 ,(31g5 l(D MO ter' -r.eLe-r-142e)44O**c"1 0 Site Plan dra n t tale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes ensions <br /> AGENT NAME CONTRACTOR NAME <br /> Q Site Plan ino u ' g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) [Set Ck's <br /> PHONE PHONE ❑Site it - � .val from <br /> app ,� - ship. , <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL MBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL BER O14 ocioc,_3403_ R -woo O.go% frontage drawn to scale. <br /> NUM <br /> TOWNSHIP: Vl.4t-O SECTION: 0'eV& 11 <br /> 3/9 1/: NW 1/4'/: . w ❑Drive y r+,Yr'its <br /> 'row", Oar ✓+P..n+r+q (state f 7.. , own) <br /> ADDRESS: <br /> (,g103 /levvesf /1/09,,, CT Wa.,NAka., lils .S3 <br /> s-q 7�' <br /> CSM: LOT SUBDIVISION BLOC <br /> K/LOT ❑Sanitarypir <br /> 3� (V l+►"t. Valle/ (public,( via <br /> ^ <br /> PROPOSED PROJECT INFORMATION • STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> =.v,ro Q.v d Q - ❑ Zoning Di 4 <br /> . QThis project is a neW building or structure. ❑ Perrrittre6se? <br /> This project is an addition/alteration to an existing building or structure. Li SANITARY SERVIC : . PERMIT NUMBER: L RuralAa s t;-.. <br /> EWER i�'EP C {newle ,�" ,,) <br /> HEIGHT IN FEET( NUMBER OF STORIES: (Not including basement)1\161:<, ❑ Wetland ' •._,•J.: ,It <br /> AREA TO NEAREST SQUARE FOOT: ShOrPaBrir t) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT. 1ST FLOOR: s :,0400. <br /> C . \�j 4, TOTAL SQUARE FOOTAGE: j, (Slopes,, $ -_,_._ 7' , <br /> �J <br /> filling/: • ' <br /> 2ND FLOOR: 3RD FLOOR: c <br /> ❑ Review ,, <br /> ESTIMATED CONSTRUCTION COST: Q� 'f<~ y <br /> (Please round to nearest dollar) ♦ ♦ ♦ . ' ♦ r^� a )l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes [ fslo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes no �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ries o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes I 10 <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 g o DDon't know <br /> 7. Is this to correct a violation? QYes in o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i <br /> 545-112(4/08) <br />