Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ; tki c , eU,,(,Ic/� .3-6()---,-e-5 , I�4e.,^.--.•-5 L�nc/ oning Status; CUP; <br /> O NER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> ci Zo Oro,: c e Q,.e.a N dci C, b,-•,lie w_% 13 SZ3 Variance(# ) <br /> CN OME PHONE CELL PHONE E-MAIL ADDRESS <br /> / !' ^a n 11".l.^,CD^� <br /> Gob-y�3�}3S( 6615.69s=/-13Z CLnr;S-t-"c,,�, F�r..,5 ' ePlan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site PI • eluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of se tic <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE ❑Site pproval from <br /> ap • abl township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El ion of property <br /> PARCEL NUMBER: CURRENT ZONING: ACREAGE: p ro p y <br /> ❑NUMBER 0 C a CY/14 Cs JCSO c iA— °-)( rontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ..13-NN( •5 L ,/4: ,/4,/. ❑ Drivew permits <br /> o -0� (st co ty,town) <br /> \ii <br /> ADDRESS 0 j� i G 1 o r; ! (,42 Q-` / <br /> CSM: LO SUBDIVISI N BLOCK/LOT ❑Sanit rmits <br /> \/•-^ A (pu • , rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> G �� I,� ; oning District <br /> . 1his project is a new building or structure. L milled Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ru IA.A. <br /> EWER REPTIC ew -xisting) <br /> HEIGHT IN FEET: NUMBER OF ST RIES: (Not including basement) �, / <br /> —7 r o ' + l.1�VVetla d/F =..plain/ <br /> / h. - -id (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) © ErOSio o I perml' �L <br /> BASEMENT: 1ST FL OR: fir/ <br /> -f- 4, TOTAL SQUARE FOOTAGE: 4, (slopes, turbance,p. .. <br /> 2ND FLOOR: 3RD FLOOR: fillln CCe ) Pin_ <br /> ° 4,y <br /> akS <br /> eview Location Survey J"' <br /> ESTIMATED NSTRUCTION COST: Q and avails Options. <br /> (Please round to nearest dollar) —0 -0 -0 -0. -1 -► $ z t� � o c7 c� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ]Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) ❑Yes ❑No ®Don't know <br /> 7. Is this to correct a violation? [Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -i -♦ <br /> 545-112(4/08) <br />