Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PRO TIDE <br /> OWNER NAME O/Gl R <br /> 27,4// Zi, 44e/2- ®ZgAing Status; CUP. .. <br /> OWNER ADDRESS (Number,Street,City,State,Zip) %/Deed Restriction <br /> '✓ 27244 c''' /eo " T N .SvA" /"/LA'2'E� W/. 53.5V O Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRES <br /> Got-669-595/ 6o8-(,49- 595/ El Ite an drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -Tog f/ooce--- ".74.414.1",•-71e.,E l/RA:Wra4i © Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> .6-37.57/4 41Y/41-4 0 a-37.57 /a //y/V- ®Setbacks <br /> City,State,Zip) .53.57k (City,State,Zip) <br /> V JAW,,.►' 4'2 4 ieereA3 so/ ,3'0,ei,✓4 444red u// 5358! Site Plan approval from <br /> PHONE PHONE <br /> 6,0875-88- vase/ 6o /J�, -gg yQ/ applicable township. <br /> E-MAIL ADDRE E-MAIL AdbbRESS <br /> i� _ r L /&e/,`o/2:01Z •'✓MT , ,.Sryzs /d!CR/ ssf2. NET 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usf) © Elevation of property <br /> PARENT PARCEL NUMBER: at A0- ZONING: ACREAGE: frontage drawn to property ' <br /> D NUMBER OCR/Z - O a / A-I e s. <br /> TOWNSHIP: SECTION: O Driveway permits /.11..-'s <br /> N n/#.4/2'E ZO %: Nvy '/4'/4: Ste' (state,county,town) <br /> ADDRESS: /I K <br /> Z7 y !_ea 1eO T SUN ,',e44/e./E lv'$.5,3.59^d Sanitary igs <br /> -.)BR <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, <br /> d/e.:)/.: — <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 45-89 Jr Al>s=sv Mga.1e// „1-7'ye y'g s.. a.,,e__ ❑ Zoning District <br /> . giThis 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: ❑ Rural Address <br /> EWER IglEPTIC '""' /5 -20/7 O /6 Z to C .. (new/existing) <br /> \//HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> • <br /> /9—8 / Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) I-, ErosionCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> +, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> /S/lv /S8 9 filling/access) <br /> 2ND FLOOR: 3RD FLOOR: s-1/05 <br /> ❑ Review Location Survey <br /> (Please round to nearest dollar)COST: ♦ ♦ ♦ $ 3 3 ! + ,5� and available options. <br /> ' • ' 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes Jo ODon't know <br /> y <br /> 2. Is there a wetland or floodplain on or near the property? BYes ow ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? igfres Elo <br /> . • - 4. Has there been a zoning permit issued for this property in the past 5 years? QYes a'o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Oyes R•lo ODon't know <br /> 7. Is this to correct a violation? QYes ('lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -0 <br /> 545-112 14/081 <br />