Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER AME <br /> 9" u •42----- oning Status; CUP; <br /> NER ADDRESS (N mb r, reef,City,State ip) <br /> r5c2 <br /> Deed Restriction; CSM <br /> 3 Iti `r`1`e lit) . J�3 5?0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> D15- 6V-71% to. -_, _ •46, -' v c- - CC3 [Fran drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME Q <br /> C, �'e- C 1-ea".y A(A.;'cx t►1`� 6.,..1 Q Sit- an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS I 1 • well/septic <br /> c,w�.� ac9-0� ?,d. .3o-rc i 3 22-o iState,Zip) (Citx,State,Zip) etbacks <br /> PHONE PHO E ) ❑Site PI proval from <br /> _ c‘Lk tj - G 7 00 appli I township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn evation of property <br /> ARENT PARCEL NUMBER: CURREN --••NING ACREAGE: P P y <br /> PARCEL �l frontage drawn to scale. <br /> NUMBER 0 /0 -a 59' vgbo a o4 2 <br /> TOWNSHI SECTIO : <br /> al. u!`ke— -S 1/4: ,/4,/4. Eh Drive its <br /> ADDRES ) (St ,c nty,town) <br /> ��� 1G)(- ?1,'N C]Sanita p.- its <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pub'-, • 'vate) <br /> PROPOSED PROJECT INFORMATION S AFF ' EVIEW <br /> PROJECT DESCRIPTI <br /> D S �,,.,-,,_ 1-/ s.- 3,- 4 nin District <br /> . [IThis project is a new building or structure. <br /> ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT UMBER:/ ❑ Rural Address <br /> F1EWER EPTIC • V /3 (ne • <br /> HEIGHT IN FEET: _ /).._ NUMBER OF ST RIES: (Not including basement) <br /> / i--. .•.plain/ <br /> u J AREA TO NEAREST SQUARE FOOT: ore ar • '- chmen#j <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FL OR: n rosionCoi t • •ermit <br /> 1 `) + TOTAL SQUARE FOOTAGE: y (slopes, .isturban•�-;- <br /> 2ND FLOOR: 3RD/FLOOR: / /i filling/a «= S <br /> eV1ew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ \ and available optiomk <br /> (Please round to nearest dollar) ol, ) S <br /> *s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? f's ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? (es ❑No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? []des ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ElKio <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) [Yes ❑No ODon't know <br /> 7. Is this to correct a violation? Dies 126-o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -► <br /> 545-112(4/08) <br />