Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEf�fy�i of 5 keilsckifi-WNERA,�D\D(-'RESS Number St oning Status; CUP; <br /> 533y (Number,4 A Zip)101 nit7Gt,(hil! � 6 Variance;1ctb0n; <br /> CSM ) <br /> HOME PHONE CELL'HONE I E-MAIL•D•RESS f , <br /> 6A -01110-79A2 •1 •$ f "� S lk Wite.Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C NTRACTOR NAME <br /> s •t jon [�,8ite'P? ncluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ,� of well/septic <br /> . q u 3 treA a <br /> City,State,Zip) (City,Stat p m �S <br /> , Aar PHONE PHONE • ' Wa s-ireo ❑Site P . .• royal from <br /> OV4) a";(2®•197 p <br /> .� p: ca. - townshi p. <br /> E-MAIL ADDRESS E-MAI ADDRESS <br /> gf��t �,�1 I oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL 0g _ S�) ! 1K , /ci(3F 3.,� frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: r/ SEC 1L•'N/{ `j <br /> `/ f t I '/4: k/ 1/4'/4: eway per . it <br /> `� ADDRESS: `�1 �•� (state, county,town 'cif' <br /> • CL.l.lCi nitary .- ..'ts <br /> CSM: �� LOT I SUBDIVISION BLOCK/LOT 1.......w <br /> (public,': ^ . <br /> STAFF REVIEW <br /> PROPOSED PROJECT INFORMATION t <br /> PROJECT DESCRIPTION: <br /> /}. ping District <br /> . [/]This project is a new building or structure. `, Use? <br /> El This project is an addition/alteration to an existing building or structure. _ <br /> SANITARY SERVICE: PERMIT NUMBER: r : I Address <br /> EWER [EPTIC /3 p-ot' -0001-6'2 1 Z fisting) <br /> HEIGHT IN FEE) ��� NUMBER OF STORIES: (Not including basement) ® <br /> ' f a e=r oodplain/ <br /> S • e • (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> a l tonCo pe it <br /> BASEMENT: 1ST FLOOR: <br /> X33s" 4, TOTAL SQUARE FOOTAGE: ,I, (Slopes diStUrb <br /> 2ND FLOOR: 3RD FLOOR: filling acres .4 <br /> �/� N� (' X Il --view Location Survey <br /> ESTIMATE CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ QD and availab ionS.' <br /> (Please round to nearest dollar) �.e�+ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Eirlo ElDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ges ❑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) EYes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes �No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />