Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> . ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> T" 't goaeittA6 �(rI`' oning Status; CUP; <br /> /OWNER ADDRESS (Number,Street,City,State, ip) <br /> ./ yo I 6c.IkjbW lg� Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> 7!5'931-O2-H1 5cr- ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ac3-44 II (�q,..i,. Gib.S ION 1 (oN31)11471;1 U_c Si Ian including location <br /> AGENT ADDRESS CONTRACTOR RESS <br /> R7 Plan <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> S' h i�, wL 5-350 <br /> /PHONE PHONE ❑Sit Ian a roval from <br /> Cc' 3-6277 applic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> car cat.fi Cons1rz,_tiw,//L@ 1100,coni • loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: p/ CURRENT ZONING: ACREAGE: vatlon of property <br /> ❑NUMBER OSI '—1s I—0t✓v-o gµ2 4umI IJ�"‘S 11,0oC frontage drawn to scale. <br /> TOWNSHIP: r SECTION: <br /> rb,,h oT Lf/q #( 15 -1/4: 5 .1/4.1/4: NW Dry permits <br /> (st e, ounty,town) <br /> v A/DDRESS:90( / t 1,40 se' 14 .4- s I► JL jl S35T 1 <br /> ` , S permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> /0 yy 1 (p <br /> private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIQN: D nn <br /> loran AIM,Grec k ' onin District <br /> . ❑This project is a new building or structure. <br /> ermined Use.. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural A. <br /> 'VIEWER S( EPTIC PV (new/- •1 <br /> HEIGHT IN FEET: ^ J /t NUMBER OF STS IE ( of including basement) © , - ,: . Rood! n/ v <br /> //� AREA TO NEAREST SQUARE FOOT: Shorel:r*•�F, "rchment) 3 --4 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) t� , <br /> BASEMENT: 1ST FLOOR: <br /> rosionControl permit *7 <br /> 4:V 136 ,l TOTAL SQUARE FOOTAGE: +, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: / �— <br /> filling/access) <br /> �6^ 1� Review • p ion Survey tj <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ \ k <br /> and avail a options. <br /> (Please round to nearest dollar) <br /> \4w <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres ❑No <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 ❑No ['Don't know <br /> 7. Is this to correct a violation? Efres ENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -► <br /> 545-112(4/08) <br />