Laserfiche WebLink
1 150 q` 6/, g° <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME i /,�/A ,^ <br /> OWNER ADDRESS (Number,Street,City,State,Zi Oning Status; CUP; <br /> Sid / 6 /30) /cid r / /ed Ijk Y,sCkA // Gti; Deed Restriction; CSM <br /> I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0g"— ' /53 k . e yVt-t cQ -t-✓onf,c2,edA, ❑_Sit+-Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM r 1 <br /> SLtivl. C9M—Ct,v- ❑Site-Kan including location <br /> AGENT ADDRESS CONTRACTOR ADDRE of well/septic <br /> /' s-'---• YHceV / can h, <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE _ ite Plan approval from <br /> /,cc?� 3c) C -g clD applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ef 5.6or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUR NT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL ��/Z _,3- 8v/S Z _ ;/ �` ( frontage drawn to scale. <br /> NUMBER `� <br /> TOWNSHIP: / �J / SECTION: <br /> TOWNSHIP: .., <br /> 17f /Flea j✓l ‘'‘- o� 'J 1/a: %1/4:_ 9- nvway permits <br /> ADDRESS: (state,county,town <br /> 5"'I 6 0 o) Cle:4 r id 6k4a- V--5 . f I <br /> ❑Sarrtfary permits ,� <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> NZ / (public, private) /U <br /> 7 I (P <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> _; 5 a SO n ""a-C., L 4.toning District <br /> . ❑This project is a new building or structure. <br /> 0.-Per t�iitted Use? <br /> This project is an addition/alteration to an existing building or structure. ,� <br /> SANITARY SERVICE: PERMIT NUMBER: �.+'i�uiai^ddr- s <br /> EWER [EPTIC (new/e <br /> HEIGHT IN FEET: q / NUMBER OF STORIES: (Not including basement) <br /> / <br /> ❑ ..•plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorelan• (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: /( ��}f <br /> Er onControl permit <br /> e? / 1 TOTAL SQUARE FOOTAGE: y slopes,disturbance, �/(/ <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> LSt tCeview Location Survey A 4" . <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ O �� O v and available options. / " <br /> (Please round to nearest dollar) 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 'es No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ls ❑No EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? D1`es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 016-- <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) Elves ©P4'6 " ❑Don't know <br /> 7. Is this to correct a violation? ['Yes ❑K <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► <br /> 545-112(4/08) <br />