Laserfiche WebLink
t ,5 e 40 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNERME �' <br /> DO /U/mb Z (40(e-- / �- p �4( s Zoning Stas4UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ' ,/J - Deed Restriction; CSM <br /> S� Z /� 6" l� OV 4 • Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS to <br /> 77a 35T6 5At- e"-- DEC bf OP,c jjA,ft 1.00064- O Site Plan dr n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl dim nsions <br /> AGENT NAME CONTRACTOR NAME <br /> �/A/" /(f) SA`A p Site Plan'n ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ e is <br /> 9, 2- / i?� It--".. g-0 <br /> �1ME- <br /> (City,State,Zip) (City,State,Zip) Se cks <br /> PHONE PHONE ❑Site PII=p•r <br /> ( X H2O CS71 2 applic•,41- • s .p. <br /> JLA RESS � j7(�Cys�;d E-MAIL ADDRESS <br /> 0 Floor plan o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation f p petty <br /> PARENT PARCEL NUMBER: CUR�"TZONING: ACREAGE; ��� <br /> 0 PARCEL !� •� 3 E/L / frontage d n to scale. <br /> NUMBER /•� <br /> TOWNSHIP: / SECTION: ,/ �`��� <br /> 0 ILE Ga tiJ 17_ y4: N/�'V '/a'/4: IvJ ❑ Driveway pe s <br /> ADDRESS: f -7 _. Q (state,co town) <br /> [ C, C � e, - i< 0 0/c- (,--D /V El San' ryp i <br /> CSM: LOT S'U,BJDIVISION O��BLOCK/LOT (pU II ti�i � <br /> PROPOSED PROJECT INFORMATION STAFF VIEW <br /> PROJECT DESCRIPTION: <br /> -fTh k.A- 64° 4P D ❑ Zoning trict <br /> This project is a new building or structure. <br /> ❑ Permittvxge? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Ad. <br /> W - <br /> EER r) .EPTIC (new/e g) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /7.— ❑ Wetlan• , ••lain/ <br /> Shorela • -ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1STfl . <br /> ❑ Erosion on+ • permit <br /> CC((.•//-�� 4, TOTAL SQUARE FOOTAGE: j (slopes, i rbance, <br /> 2ND FLOOR: 3RD FLOOR: /� <br /> filling/a..- <br /> I/52Ei Review ion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -► ♦ O/ and avai a options. <br /> (Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes 4fINo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? 'es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres Dlo <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) QYes o ODon't know <br /> 7. Is this to correct a violation? QYes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -P <br /> 545-112(4/08) <br />