Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to,web App;#'. <br /> PROPERTY OWNER INFORMATION: L*-';-M-C. CUSTOMER TO PROVIDE <br /> OWNER NAME 1' 1,� <br /> Pcw`` 'R' G` r^I A� oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) �J, S�S9r Deed Restriction; CSM <br /> / 30 (8 A40) )cG��.e,\t) ik. Sum \v,1s 2 11 Vin )HOME PHONE ELL PHONE I AIL ADDRESS <br /> - 1008 T)i 0093 ' e Plan drawn to scale <br /> AGENT.INFORMATION 'CONTRACTOR INFORMATION '° "; and in des dimensions <br /> AGENT NAME CONTRACTOR.NAME <br /> �it*�(VO\/S+�`w 140 ,ejy+\Sk'1/.' CAI(C) ' e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Lf s( s n -{, Rt sq <br /> V (City,State,ZZp) (City,State,Zip) r {backs " .a <br /> COAfay,GYO VA �( 535.0. g <br /> PHONE PHONE ❑Site an royal from <br /> (Do d ??5' C/If 8 ap ' e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> V.0-6 g gy,,,Q,\ U, oor plans to scale <br /> ;,PROPERTY/LOCATION INFORMATION (httpilaccessdane co lane wr i0/ Ny" r <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: i vati property <br /> PARCEL BER � 1 q'� ��3 l q$7� front ge awn to scale. <br /> NUM <br /> TOWNSHIP SECTION: <br /> BY') 01 _\ ,/4_ %1/4: El Drive ermits <br /> ADDRESS: 1 (st ,c nty,town) <br /> 361 S t\O\f)P\--) va U ` 'C3- SuV'PV' t'1`( lr'( -S?5 )Sanit. :ermits <br /> CSM: LOT dBDIVISION BLOCK/LOT <br /> C 0 S / (pub' private) <br /> • ; I • . - ; I . a : I! : a - STAFF REVIEW <br /> PROJECT DESCRIPTION:(� , 1 a <br /> -e- �„Q,d t- ) 1(1,tt,� �/ ,)�, tying Disfnct <br /> ❑This project is a new building or structure. r <br /> ermitfed Use? , <br /> This project is an addition/alteration to an existing building or structure. _ k-- f <br /> SANITARY SERVICE: PERMIT NUMBER:r NI RufalAddfesSt <br /> EWER PTIC /J A -new/ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) N <br /> 1I „,-.)etly .odplai - <br /> ore` la. ,achment) <br /> AREA TO NEAREST SQUARE FOOT: `` r. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) : �,� <br /> R) Erosio Con trol p_rmlt <br /> BASEMENT 1ST FL0Q8� r �a r <br /> C 4, TOTAL SQUARE FOOTAGE 4, = slopes z a-Ce ° <br /> �7 _ � filling acc `s}' <br /> 2ND FLOOR: 3RD FLOOR t M +-. { <br /> Review }o lop Survey <br /> ESTIMATED CONSTRUCTION COST: d and a, fe options <br /> (Please round to nearest dollar) ♦ -•0 ♦ --0 ♦ ♦ $ 1 <br /> ivo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies M,Jo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Wes C►a�4 ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? al t es QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - I. es AZINo <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) Dyes [llo ['Don't know <br /> 7. Is this to correct a violation? QYes Tqici <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -► <br /> 545-112(4108) <br />