Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTO R TO PROVIDE <br /> OWNNE,RNAME 1 (.�, <br /> a/ ctr CA4hy (. `OCO\ ping Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> eed Restriction; CSM <br /> ( 2..94 Temple-1-0A Terrac-t_ ,S•)n TtQ- t W? S-3 c-50 Variance(# ) <br /> HOME HONE CELL PHONE E-MAIL ADDRESS <br /> - 34 7692 <br /> e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAM C NTRACTOR NAME <br /> 14 1 o f �ar &I i crS 0 Site an i ding location <br /> AGENT ADDRESS ((`` CONTRACTOR ADDRESS of w tic <br /> 1S71 COn.' tf C - CC <br /> (City,State,Zip) (City,State,Zip)- '" 'C etbacks <br /> De -occs - k)= SS32 <br /> PHONE PHONE 0 Site P :. .pproval from <br /> 6200-gy(o- 334t( ,o1 - 2.2S'- Oo/sE) ape . -• - township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Kce( e et-a-0104 by . 1 (J� ,se . , 1 oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT Z 1 NING: ACREAGE: El ation of property <br /> ElPARCEL �I O oa i 3s3q a A— . �-•� ontage drawn to scale. <br /> NUMBER <br /> TOWNSHIFh SECTION: tip <br /> �Kl/{` IA: .41/4. ❑Driv- ' pe <br /> ADDRE/SS':� L� _ �^ (state, co■ •;,,town) <br /> / v ` 0 - ••r_ .-emits <br /> CSM: LOT SUBD ISION :LOCK/L T <br /> Ci �„J ,` j'A (public,priv. e) <br /> PROPOSED PROJECT INFORMATION Caw ST F R IEW <br /> PROJECT DESCRIPTION:R B I aC C. C) w JG�� � o Q►^ l6 i © ing District <br /> . ❑This project is a new building or structure. P ed Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 1:3 Rural ` • _n <br /> EWER r)EPTIC n_ /e�fisting) 1 <br /> HEIGHT IN FE T: 1 NUMBER OF STORI S: (Not including basement) Q ,,�i,, <br /> Wetia 4 .',a+:ain/ <br /> _ / `(� Sh• - e - ,.:chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) /I ._ , , permit <br /> BASEMENT: 1ST FLOOR:c Erosion._ <br /> �7 G j TOTAL SQUARE FOOTAGE: ,l (slopes �. .ance, <br /> ft - .t access <br /> 2ND FLOOR: 3RD FLOOR: ' 1.5- <br /> ESTIMATED CONSTRUCTION COST and a '. + n ions <br /> ♦ .■ .♦ ♦ ♦ ♦ I/ and a •-+e _ ptions <br /> (Please round to nearest dollar) % Oa) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes INlo 00on V't la <br /> 2. Is there a wetland or floodplain on or near the property? Oyes El\lo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? OYes EIVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes nsio <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) Oyes ao ['Don't know <br /> 7. Is this to correct a violation? Eyes .lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ —► -► <br /> 545-112(4/08) <br />