Laserfiche WebLink
• <br /> SU0LEMENT - YYeb Ap <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> • <br /> PROPERTY OWNER INFORMATION i --.. `;- i _'r : ,� r V-i7.-S CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> De el l se 1-G b r e i oning Status; CUP; <br /> OWNER (Number Street,City, ate,Zp) p J Deed Restriction CSM <br /> 1 `7 7� �i�� � U!'ovUrl ir. W� .�3SoZZ Variance(# 3� `� ) <br /> HOME PHONE CELL PHONE E-MAIL DDRESS - <br /> .D ., 5—g . va//-e v/Ck( t&s• ne4— Ian drawn to scale <br /> AGENT NFORMATION _ - _CONTMOTORyINFORMATION M t,,,_ s% and includes dimensions <br /> 'AGE�(T NAME n_ CONTRACTOR NAME - <br /> �)0fif ' "?hie'Vail D'Sif Plan including location <br /> AGENT AIDDRESS CONTRACTOR ADDRESS of well/septic <br /> 13 5-3 R.44-lehje . <br /> (City State p) (City,State,Zip) Setbacks <br /> f 4a S 1's a it IA/l:. 5 3 7.0 3 <br /> . PH NE PHONE Q Plan approval from <br /> v - b 0 1 5. —a 1 y7 3S - applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Aa J M p 4Y00 ,p,* ( ,e 0 m loot plans to scale <br /> P.ROPERTYILOCA LION INFORMATION ;(hftp//accesdane eo_danewi:usiM�_�t;,.,� n C,wation of property <br /> PARENT PARCEL NUMBER CURRENTZO NG : ACREAGE . D-Be <br /> DPARCEL LL �n ` _ Q frontage drawn to scale. - <br /> NUMBER QN�O-)7.2 "Q?�'f ) I 5 1 <br /> TOOW-NSHIP: SECTION: <br /> / l ADDRESS: to.e 7i ✓11 - )� I : /V k1 j/a: At& ❑Driv permits <br /> v ADDRESS: (st , ounty,town) <br /> 113 7 3 D-0,41.04 ,pr ay)i - D : D San- ermits <br /> CSM: LOT ► BLOCK/LOT <br /> (P ic, nvate)/0 ru s .MA • <br /> PROPOSED PROJE CT INFORMATION c = '__ . <br /> x � �.STA� RE-'1[IEW� <br /> PROJECT DESCRIPTION: r. a .� -�- <br /> ,fir `-kstf- <br /> . prhis project is a new building or structure. • ..t� ;"e'' s._e ,.a..' F <br /> ,ae Iffi?:dUse?fir;: <br /> This project is an addition/alteration to an existing building or structure: - iarfA -='-• A' <br /> PERMIT NUMB =UyRureliA� Ss- -'<.., <br /> SANITARY SERVICE Eq y -.�: .�:. -:.: -_ ,` %s •:r <br /> EWER EPTIC • N e <br /> NSW- sari•y. __-Fr= -��;. <br /> HEIGHT IN I- <br /> P. <br /> S NUMBER OF STOR ES: (Not including basement) XVA- -"1--, •` ^YY",J'- <br /> -- ' �'- Fre tit i't"A;<' .. <br /> AREA TO NEAREST SQUARE FOOT ;_ _-,4: laii,� - chment)-ti , <br /> 'r :. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) -:-�-" :5 t'. <br /> "'rosio�ControL It <br /> BASEMENT: 1ST FLOORt —�", ri " <br /> • S - 4.TOTAL SQUARE FOOTAGE: 4, slopes, IStliri7anCEI,4t r J7 <br /> J 1i •;acoess• -1-i <br /> 2ND FLOOR 3RD FLOOR 4 --y. s.- O C <br /> • . v if'mac'- ,,,,i•� 3 � jJ �c� :vd S ey=> <br /> e �evle ��Loeatl•pr <br /> ESTIMATED CONSTRUCTION COST: Q� n a�nd'a ilab trpti s -'-{ <br /> (Please round to nearest dollar) --I- --► -�► -•� -` --� 'P `J - " `- .. "` �'' -~'`re <br /> - <br /> • 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes ONO ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? VIYes DNo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? VIYes ONo <br /> 4• Has there been a zoning permit issued for this property in the past 5 years? - Dyes no <br /> • 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> • <br /> 6. Is a location survey required? (see reverse) ['Yes • alb ODon't know <br /> 7. Is this to correct a violation?- DYes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) .-* -9. —0'545-112(4108) -- . <br /> • <br />