Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME - f- . _ <br /> S(�)tn ^ onk1 W 7L Wing Status;CUP; <br /> OWNER ADDRESS (Nu ber,Stre t4City,Sta e,Zip) <br /> M iJi'.uk., AA., /Jdirey / roue �; 7 Deed Restriction;CSM <br /> l7 L C7� Variance(# ) <br /> /HOME PHONE CELL PHONE E-MAIL ADORES <br /> i <br /> 'v ,�►`� - c/ —Sl Z/ 14..J 3rOnk e /'G • cam-" Site P drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/ ptic--.>(City,State,Zip) (City,State,Zip) S backs <br /> PHONE PHONE El Site P approval from <br /> ap cab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS loor plans to scale <br /> fa PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCE UMBER: CURRENT ZONING: ACREAGE: ation of property <br /> ❑PARCEL 00 0 71>-W-837/ I c--7 9 NUMBER t"--7� frontage drawn to scale. <br /> TOWNSHIP: S CTION: <br /> e my ( 12J%.r,,� 1/4: '/4'/4: ❑Drive rmits <br /> ADDRESS: dd /� (st , o ty,town) <br /> / �g /, g"tw L,u, a�l Z W, 5.--35.:92 7 ❑Sanit p mits <br /> cS LOT BDIVISION BLOCK/LOT (publi vate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO CT DESCRIPT ON: # 11 �l p� <br /> �[iJ1 del' At 1Z"6 u `01.1 p A �4-C (3,, Z ing District <br /> . ❑This project is a new building or structure. P fitted Use? <br /> rik is project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> EWER laEPTIC IV (ngiStifit <br /> HEIGHT IN FEET: NUMBER OF STORI JJJS:1111(Not including basement) <br /> 1 d/F odplain/ <br /> ' <br /> Shore! achment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Ero CO of permit <br /> j TOTAL SQUARE FOOTAGE: ,` (slopes, • urbance, <br /> /ISa—� � � = y3 filling/- ,;. <br /> 2ND FLOOR: 3RD FLOOR: 1 <br /> f U 27 - -view Location Su ey <br /> ESTIMATED CONSTRUCTION COST: )5 . - d availabl- '. <br /> (Please round to nearest dollar) --► -0. -11. -4. ♦ K <br /> y6s- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I3 ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies 10 ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [ lo <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 El•o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes 1:a1 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/08) <br />