Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Phil krisfiy FrtderiLkSon <br /> oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Nr x}319 Vhlgt R4 (et I-9,11., (7res&_ INT. 53. 2 -7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0,*- y ; "' CM ❑ i plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 1 j CONTRACTOR NAME <br /> R4YI i ) gs1Ji(I H/If)9ooi7S , Spg5 ❑Site P including location <br /> /AGENT ADDRESS CONTRACTOR ADDRESS of well/s tic <br /> Pa (o 415'6 <br /> (City,State,Zip) (City,State,Zip) ELS tbacks <br /> Moot-tile wr.. 5-31 y y <br /> PHONE PHONE ❑Site pproval from <br /> cog.— c- 11 oC ' - x.97- 2,922- appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r ti9r-d c,II E ; poctJ • cor1. ❑ Flo plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑ Ele -tio� of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL co \ R G_ J yK S H- D- ' J front.•- drawn to scale. <br /> NUMBER c:7// 7 qS Q� 1— / ""I <br /> TOWNSHIP: SECTION: <br /> ATown o-1 c c r*N'L G ✓� '/4: '/a1/o: ❑ Drive . permits <br /> DDRESS: (St. -, tounty,town) <br /> 4311 viigfA4 Ccfivc. (9/rdt_ w.l <br /> ❑Sanl ermits <br /> CSM: LOT iii SUBDIVISION BLOCK/LOT <br /> (pu ' private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 18 K (10` I h q✓0✓0 1 Pool 11,2�/oni <br /> n District <br /> . <br /> This project is a new building or structure. <br /> rmitted Use'? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBrRI {4 Rural A.... e� <br /> FIEWER PEPTIC 1 " // j <br /> (ne • <br /> HEIGHT IN FEET: ` NUMBER OF STORIES: (Not rincluding basement) <br /> Web d/F dplain/ <br /> Sh d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> Eros' nC of permit <br /> BASEMENT: 1ST FLOOR: tUrt)ariCe <br /> 1 ^ l TOTAL SQUARE FOOTAGE: ,, (Slop , , <br /> 2ND FLOOR: 3RD FLOOR: <br /> _ l fi . g/acre ) <br /> Revie Loca• n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �� pp and avai pitons. <br /> (Please round to nearest dollar 160 0• <br /> I-, <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? Ekes ❑No ['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 2-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 [tlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -4 <br /> 545-112(4/08) <br />