Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> i PROPERTY OWNER INFORMATION C -TOMER TO PROVIDE <br /> OWNER NAME <br /> Ii AKL3N O ✓I i-Av <br /> OWNER ADDRESS (Number,Street,City,State,Zip) El Zoning Status; CUP; <br /> c f f 5 L o v vey a �- m r /tot' W 1, 535-72- Da ianceestriction; CSM <br /> g!', HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (# ) <br /> bOS" S'te Plan drawn to scale <br /> 'I li AGENT INFORMATION CONTRACTOR INFORMATION d 'ncludes dimensions <br /> 1 AGENT NAME CONTRACTOR NAME <br /> ii i Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/septic <br /> ,I (City,State,Zip). (City,State,Zip) 0 Setbacks <br /> PHONE PHONE 1 El I e Plan ap al from <br /> plica ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> .1 PROPERTY/LOCATION INFORMATION (httpa/accessdane.co.ciane.wi.usn Elevation of property <br /> i'i PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p ro p y PARCEL frontage drawn cale.' ❑ 0 0767-13 - 95'00-b' A -( (g i Y�NUMBER <br /> TOWNSHIP: SECTION: <br /> C(-eSS P4-/I-lti5 g 1/4: 5W 1/41A: Sc Li Drive permits <br /> ADDRESS: <br /> (s , county,town) <br /> cfys'o cc�v,*'ry .1, 7 ❑Sanitary --rmits <br /> Ill CSM: LOT SUBDIVISION BLOCK/LOT <br /> (s bli•, private) <br /> 1. <br /> PROPOSED PROJECT INFORMATION 'AFF REVIEW <br /> PROJECT DESCRIPTION: , '..' <br /> ra5T l�AMO gU /C-p (41 G- • Xf o ing District <br /> ❑This project is a new building or structure. <br /> , D��-rnlitted U TM <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A dres <br /> r)EWER EPTIC (new/ex tin , <br /> HEIGHT IN FEET NUMBER OF STORIES: ( of including basement) <br /> l6 Pr 1-42 P/1�,� q �q 44 ❑ Wetland/F cJplatn/ <br /> I. Shore) d (attar ":'ht) <br /> i AREA TO NEAREST SQUARE FOOT: <br /> '1 1 (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: . 1ST FLOOR: ❑ .ErosionCOn l permit <br /> TOTAL SQUARE FOOTAGE: �, _(slopes turbance,;;_ <br /> 11 i II <br /> I ��' 2� filling/. cess) t <br /> 2ND FLOOR: 3R FLOOR: <br /> ' <br /> Review Location Surve <br /> 1H ESTIMATED CONSTRUCTION COST: ♦ -► -► ♦ ♦ ��� G O o and available options <br /> I (Please round to nearest dollar) <br /> 1 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des 'No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 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 ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> A 6. Is a location survey required? (see reverse) ❑Yes alNo ❑Don't know <br /> '' 7. Is this to correct a violation? ❑Yes .No <br /> 41,! 1 r co <br /> APPLICATION MUST BE SIGNED <br /> sas t1z faros) tit (Continue on Back) —► —► —►I I <br />