Laserfiche WebLink
CTI` '' SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> LJ .-- -\-\\-v<rP\S 'NQC 0 C ❑Zoning Stat ; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Iction; CSM <br /> LA\'"16 R,k-Nio,N `( C:"C- w■c-i---P?-Ll1n►z ,'E__ S"S r. Varianc (# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60i5'-aa0-5S50 NOcZo $ 5%&`�" "". • "',_ ❑Site Plan dr w to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includemensions <br /> AGENT NAME CONTRACTOR NAME <br /> COQ Site� ADDRESS of wbI15 <br /> alt-acv C2 ( Ro p,g, <br /> (City,State,Zip) (City,State,Zip) ❑Setbt s <br /> E R.4- 9 SISSY <br /> PHONE PHONE <br /> El Site PI n .•• • <br /> .1 from <br /> 6,..!---c5-6D.(6-i-t.W.)`1 applic,• - t rA ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Q Nt��O&j. ,jutz., M ❑ Floor planie o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation ooperty <br /> PARENT PARCEL NUMBER: CURRENTZONIN ACREAGE: <br /> ❑PARCEL 62_sybNO --16S-2-y p�L y frontage dra n to scale. <br /> NUMBER V <br /> TOWNSHIP: SECTION: <br /> � I`�� } <br /> ° 1�4: ,%4,A: ❑ Drive p Its <br /> ADDRESS: (stat , utown) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> Vkabes 4- k (public, private) Dial' <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> PN(3■c3:\VI0ki 'a$?--C-9L-ic Q ❑ Zoning Vitt <br /> . ❑This project is a new building or structure. ❑ Permit! ? <br /> This project is an addition/alteration to an existing building or structure. ""uv <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Rural Address <br /> ?EWER FIEPTIC (new/exidle*) <br /> HEIGHT IN F T: NUMBER OF STORIES: (Not including basement) <br /> 15 , ❑ Wetlan.r l•.•1. <br /> Shoreland (- , • ••_ e <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions inc uding unfinished area attached garages and above grade decks or porches) 1--, ErosionControl •errrllt <br /> BASEMENT 1ST FLOOR: <br /> c\St\ ck< t` 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> \C‘bg ❑ Re on Survey <br /> • ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ an. • •` :�l'�®ptions.' <br /> (Please round to nearest dollar) $ \ac �o I" <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives 0 N ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives 0 o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? `Wes /No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes NNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I:ave blank if none) <br /> 6. Is a location survey required? (see reverse) '"-':! es ❑No Oon't know <br /> 7. Is this to correct a violation? . es fq.o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) — -► -+ <br /> 545-112(4/08) <br />