Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> f <br /> NIL40 lilt S i- J4 F�StZAAwID • CAW ELLf OI.SEN 0 Zoning t us; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re friction;CSM <br /> 10113(0 OLD Y R.D, Mq zo mAN lE, on 53 slo 0 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> lone) 577-5712 heAlenbrnc,25® 0-1,00.00111 ❑Site Plan dra to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME n <br /> -flat PLL $s4.ITS, L.L.C. Q Site Plan including location l <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /09 ReaNEs cr <br /> (City,State,Zip) (City,State,Zip) ❑SetbS <br /> MOUNT IftWee, WI 53S7L <br /> PHONE PHONE ❑Site Plan ap r9Ial from <br /> (6* q57-4042- applicable toJVhship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> S14,-fterT®wausau,ho nits.corn ❑Floor plans to 11 le <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of pr p <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL pd o(02$t,3100 frontage drawn scale. <br /> NUMBER RN' 2• 'Ic.RFS <br /> TOWNSHIP: SECTION: <br /> M Azo M AN 1. 2e 1/4: NE '/4'/4: N(f4 ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> I 041 0LO Y RD <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 122.0 I (public,private) <br /> PROPOSED PROJECT INFORMATION -�y� STAFF REVIEW <br /> PROJECT DESCRIPTION: yew �,,cr IQNJ1Zt CT1O N <br /> t'Y VW� LI Zoning Dtyitf <br /> . <br /> This project is a new building or structure. ❑ Permitted ? <br /> This project is an addition/alteration to an existing building or structure. V <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ado - <br /> EWER *EPTIC ' 3 - zo 0--ea/83 (new/exi,ting), <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2o'- 3 Va." 1 ❑ Wetland/Flo pl i <br /> AREA TO NEAREST SQUARE FOOT: Shoreland ( nt) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionConi�o rmit <br /> BASEMENT: '206 ` <br /> 1ST FLOOR: 10, 1 TOTAL SQUARE FOOTAGE: j (slopes, r�i e, <br /> f" ♦ filling/ac ss <br /> 2ND FLOOR: 3RD FLOOR: <br /> • 34240 )15D <br /> . ❑ Review Loc 'or -Survey _ / r— <br /> ESTIMATED CONSTRUCTION COST: and available ptions. �V' <br /> (Please round to nearest dollar) '♦ ♦ ♦ -io ♦ -► $ 1 e3,75-0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes @lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Rfres ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes l'10 <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 �(Vo ['Don't know <br /> 7. Is this to correct a violation? :Yes E Jo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) • -I) -► <br />