Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION 0FFICE°USE";5ONLY <br /> OWNER NAME <br /> �Z°5NNi.f1 � <br /> ��V � ❑ Zoning District <br /> OWNER ADDRESS (Number,Street,City, ate,Zip) = <br /> -S-4-2) 10(46- 2-. �b 1 �� .Ni ILt , �,?1 S:3SC� j <br /> ❑ Rermltted Use? <br /> PHONE E-MAIL ADDRESS '9 - <br /> i'CE S" 6 �4i11N i �t S , l l ❑ Zoning Status,CUP, <br /> AGENT INFORMATION I CONTRACTOR INFORMATION Qeed Resjiction CSM <br /> Var <br /> AGENT AME CONTE2ACTOR NAME <br /> N <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> 0 She-,,Plan drawn to,scale <br /> .' at id includes dimensions,.' <br /> (City,State,Zip) (City,State,Zip) <br /> t Site Plan including location <br /> PHONE PHONE <br /> of"Weil/Septic ' <br /> E-MAILADDRESS E-MAIL ADDRESS ❑ SetbaCKS ; <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ste Ian approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> Li PARCEL 2 apP Icable townShlp <br /> NUMBER en-04-ZG�'�jS -S l -3 Z3 1 <br /> TOWNSHIP: SECTION: <br /> � , , �❑ Rural Address ��� <br /> �iZ rr� SSE Z-�c /e. N1,- /a/: 1`)(''') ^a,t., , v/existing) 2 <br /> ADDRESS: <br /> Sit 8(?c, Ie S �/� ❑ Floor plans"to scale <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> gCc�°� l <br /> D Elevation of property <br /> PROPOSED PROJECT INFORMATION frortfage drawn to Scale <br /> PROJECT DESCRIPTION: <br /> NE C.,A e-/�� C7 D IVeway perms Its <br /> I�This project is a new building or structure. (state,county,fawn) <br /> • --1--1 This project is an addition/alteration to an existing building or structure. -g �:1'4 ,, <br /> SANITARY SERVICE: PERMIT NUMBER: Sanitary" emits <br /> ❑SEWER ❑SEPTIC (public,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1G Z>6� 'r I <br /> ❑ Wetland/Floodplain! <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: �;- 5, '. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 EroslanCotttroi permit <br /> BASEMENT: 1ST FLOOR: i 7C / (slopes„disturbance, <br /> A A `3 Z Ah 4, TOTAL SQUARE FOOTAGE: ,l A P <br /> '�) filling/access) <br /> 2ND FLOOR:/ 3RD FLOOR: <br /> Z <br /> �� 0/4 /5 Cr- 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ _ ♦ _♦ ♦ $ -i Off, CI?) <br /> and available options <br /> (Please round to nearest dollar) iz <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. There is 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? I Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No )(+ KKA191A) <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? <br /> 126'es ❑No ❑Don't know <br /> 7. Is this correcting a violation? CI Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ _•. —► <br /> 545-112(1/08) <br />