Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to wee-App;wR <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA t J <br /> Oter�0 LA; thjvi /4-gr\h i) CA" v►'l ❑Zoning Status; CUP; <br /> OWNERA ESS (qber,Stre • ,State,Zip) I Deed Restriction; CSM� (� '7'�/ l / 6 �(0'1 � � ( Variance(# ) <br /> HOME PH NE/ ( CELL PHONE E-MAI(ADDRESS <br /> ryl-,ot i so rt.)1 W L mail,14/" ‘Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT E CONTRACTOR NAME J <br /> %ht h,e)relerT C� 7 -.0'/ povl 1�.,z_c. EKte Plan including location <br /> AGENT A DRES CONTRACTOR ADDRESS of well/septic <br /> ,)yq0 /-e.�� C she. lA <br /> (City,State,Zip) _ (City,S Zip) Setbacks <br /> Sire i1 Pr-iti 1'�i� "�� s-.3590 S h— <br /> PHO v PHONE ite Plan approval from/VA-- <br /> O pils-70 ?c applicable township. <br /> E-MA LADDRESS E-MAIL ADDRESS <br /> n Ot-( (net i01 ,00i1 r �j�';-y4 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ID/Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: A REAGE: <br /> ITPARCEL ) �j 7 frontage drawn to scale. <br /> NUMBER I2/��i1 -301 �3v l /4 -1, ►J( ` <br /> TOWNSHIP: SECTION: <br /> Ors"s f�j 1 9O '/a: .S[ 1/x1/4: Al F- riveway permits /A <br /> (state, county,town)" <br /> ADDRESS: 76 / 1 ).� y i i <br /> CSM: I,l vn LOT /!/ SUBDIVISION BLOCK/LOT anitary permits <br /> / ( �;y h 14- , J (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION:,---' <br /> K,'re S'4, atoning District <br /> . This project is a new building or structure. -permitted Use? <br /> This project is an addition/alteration to an existing building or structure. �,----�, ,�.,/� <br /> SANITARY SERVICE: PERMIT NUMBER: — '.l_1-K ral Address <br /> FIEWER r)EPTIC (new/ listing); <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) AA yp^` <br /> etland/F000dplain/ !V -- <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) Lj-tosionCOntrol permit <br /> BASEMENT: 1 TF *OR: <br /> S cl. -/ da01 a• `�ts j TOTAL SQUARE FOOTAGE: + i urbance, <br /> filling/access) <br /> 2ND OOR: <br /> 3RD FLOOR: o <br /> 1`'��% I eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: a� and available options. <br /> (Please round to nearest dollar) ... mar .---- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? fYes [al lO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? (❑1Gesr- ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ❑D) ( <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) Des ' No ❑Don't know <br /> 7. Is this to correct a violation? Lives Drib <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* –► -+ <br /> 545-112(4/08) <br />