Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTO TO PROVIDE <br /> OWN NAME t <br /> k-auk-I ncfrer ning Status; CUP; <br /> WNERADDRESS (�' r,Stre t, y,St zip) n (� eed Restriction; CSM <br /> r° U 3-1 lac` errs o / X 6IacF� ,✓f1 w/ S 3�►5 <br /> Variance(# ) <br /> HOME PHONE C LL PHONE E-MAIL ADDRESS <br /> %C I ) 7 t 1- 5754 Co g)cy1 )K i 7 A av ere.ICts./'‘c� S' Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTO NA , <br /> CI ears !3. Id"`J C0r19' ❑ Site PI-: ncluding location <br /> AG T ADDRESS CONTRACTOR ADQRES of i 0tc Pact, ;-t <br /> t • IC <br /> (City,State,Zip (City,State,Zip) F --tbacks <br /> V.e.rern 0-, 1,1/ 5-3 Q.) <br /> PHONE P ONE 1` Sit Ian approval from <br /> ) Yi T - Q 7cr') plicable township. <br /> E-MAIL ADDRESS -MAIL ADDRESS / nn <br /> Y erDll a, L C,I Lc�VN}jt,,lain;' t-J's, FI plans o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURB NTZONING: ACV Elev on of property <br /> rty <br /> ❑ Q NUMBER "7 O h on/ ��p O c ,— / T ' <br /> ntage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> e)('y`^O y.' 1/a: 1/1/: ❑ Dri a •ermits <br /> ADDRESS: (stat- •unty,town) <br /> %t--- - • ?;! El anit- . • mits <br /> CSM: LOT Aci -UBDIVISION BLOCK/LOT (p - c, • ivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> p P OJECT DES IPTION: <br /> °� 1 5 l ,to..%e f�'v o c o �j ZO g District <br /> . ❑This project a new building or structure. 0 is ttted Use? <br /> ❑This project is an addition/alteration <br /> p � t0 an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUMBER:L\/ LI Rural Ad <br /> ' v new!- stir . <br /> EWEREPTIC /� sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> \' -.--' o Weida 0, •;•dplain/ <br /> ` S • an• attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) :0 Erosi© OI permit <br /> BASEMENT: 1ST FLOOR: <br /> 1 + TOTAL SQUARE FOOTAGE: + t(sb + <br /> rbance, <br /> 2ND FLOOR: 3RD FLOOR: )�i t i) #lac,, ) <br /> 0 Review •�«== •n Survey <br /> ESTIMATED CONSTRUCTION COST: and av- ' e e options. <br /> (Please round to nearest dollar) ♦ $ 35 4., <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes No o t now <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes �No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes CKNo <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) ❑Yes RNo ❑Don't know <br /> 7. Is this to correct a violation? :Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i -► -► <br />