Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM�'� ( ari <'� , <br /> .��1F��1 \'�'",r„`I til ni <br /> ong Status; CUP; <br /> OVVINIER ADDR SS (Num a Street,City State,Zip) M 1 A t 3 Deed Restriction; CSM <br /> '.// � Br e- c�+ ! �Ct7-0� 'ark'ke, Ala_ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> i.6'',h 1?`:"--.—12L-1, k rCIra.&ri cW eirn e• C O ' \ agrte Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGEIsfp NAME CONTRACTOR AME ' /�_ <br /> ii J /1c. Z/fh.G1+.■ .'- ,rte, /AZ/i 1 INC i Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ;35-5- d--I.) - ,4i e Sam <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> D�46.1%//e t '2 S35 33 S" <br /> PHONE f / PHONE Plap approval from <br /> co c -- fe72 (c s)'- 935 23 J - applicable township. <br /> E- LADDRESS/ / E-MAIL ADDRESS <br /> C �S .Goa//ir/w■ �/H ..,,4h.6../ f ; i,c& oorplanstoscale <br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi-us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: vaOn Of property <br /> El NUM ER 0 ,06-/€,- /- R/T <br /> 1 c- G/- y, 06'6" frontage drawn to scale. <br /> TOWNSHIP: SE T <br /> a,?a'l't ah,"t e1/4: X414)%%: /j/Z— ❑Drivew rmits <br /> \.7 ADD RESS: / (state ty,town) <br /> / <br /> l U q1/g !7`' 0 i2 _ Sanitary permits y / <br /> CSM: LOT SUBDIVISION BLOCK/LOT p <br /> (public,private) <br /> t� <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: 1 � �/ <br /> R .s/0J/Iv e ,4 /W/Ks Li-c-ng Diem <br /> ct <br /> . ZiThis project is a new building or structure. Ul.F‘riitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT B ❑ Rural Ads.ess <br /> FIEVVER 45qEPTIC (new/ 'e•` i' <br /> HEIGHT IN FEET NUMBER OF STOf2IES: (Not induding basement) <br /> yf��. 1:1 wl�i e e alr/ <br /> AREA TO NEAREST SQUARE FOOT: S110f@ ° = r_r rYiettt <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ E antrol permit <br /> ft)0 4, TOTAL SQUARE FOOTAGE: +, (al , 1 thence,, <br /> 2ND FLOOR: 3RD O " /) filling/access) <br /> °� 5 (J eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ /J�U 6-0# and available options. <br /> /(Please round to nearest dollar) % U <br /> 16 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑YesNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? EFes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ,a10 <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) Efres 0 o QDon't know <br /> 7. Is this to correct a violation? [Yes Pj lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i <br />