|
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App E
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNNFR NAME 1
<br /> Qr
<br /> lt CIL— Qi_ N (wile. Cocht. l ok 1(.. ❑Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City.State,Zip) y,(��� f Deed Restriction; CSM
<br /> ' LI LI .3 La }'1 eJ' V'd t �'(�.lf-�S '\C I I Variance(# )
<br /> kletott'PFiOIQE Ce,Ll (ICELLPHONE 10(d'NL E-MAIL ADDRESS
<br /> ec----3-t,d2,--LIN..5(4 .. , (,0-43 _,,,-, n Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CTR CTOR NAME
<br /> O11f`t L`._ -Y4u i40.40 n Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> LC Li 7 La.-vac),ef- {
<br /> (City,State,Zip) (City,State,Zip) _ n Setbacks
<br /> b'�.a1�.sLL0(( (Ai% s7 _-c 5
<br /> PHONE PHONE� � car cod; n Site Plan approval from
<br /> lo(/� 3. 1 g
<br /> 7 - (L/t/3 �9„s-t.p.i.,,,1 applicable township.
<br /> E-MAIL ADDRESS E-MAILADDRESS
<br /> ,1 \42.- --1.- - \ O,d i7G,t,CL� n Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wl.us/) ❑ Elevation of property
<br /> •ARENT /PA)RCCjELNUMBER: p,.f7 CURRENT ZONING: ACREAGE:
<br /> M
<br /> NUMBER
<br /> ( O 1 ~ AZ) ."�� RM-8 ,i -r ac) frontage drawn to scale.
<br /> TOWNSHIP: 61 SECTION:
<br /> --t, t f\cL y4: +/,: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> 5(-((-(6 LQ ree_r e-cl 1"na.r5Lci l.t t.J: i S 3 s5 `I
<br /> CSM: LOT SUBDIVISION BLOCK/LOT n Sanitary permits
<br /> 5221 1 (public, private)
<br /> PROPOSED PROJECT INFORMATION STAFF REVIEW
<br /> PROJECT DESCRIPTION: ��((�� 1
<br /> v"P�, 1PoV(.(- Qfr\ (J
<br /> 11+ t? \"\Dt, e - 4 Lop --
<br /> CI Zoning District
<br /> ❑This project is a new building or structure. TION 6/2c421
<br /> ❑ PermittdNN FIRM OLD
<br /> ❑This project is an addition/alteration to an existing building or structure. M�-IOUSE UNINHABITABLE
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Andress EX
<br /> new/existing)
<br /> EWER li"SEPTIC ( g)
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) PON D NORTH
<br /> \ 4A) 1 ❑ Wetland/Floodplain/ <1000', >300
<br /> Shoreland (attachment)
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)
<br /> BASEMENT; 1ST FLOOR: ❑ Erosion Control permit NO
<br /> 9/,_ 4, TOTAL SQUARE FOOTAGE: ,+, (slopes,disturbance,
<br /> 111 filling/access)
<br /> 2ND FLOOR: 3RD FLOOR:
<br /> 0.0 (i&
<br /> U Review Location Survey NG
<br /> ESTIMATED CONSTRUCTION COST: le and available options.
<br /> (Please round to nearest dollar) i —I.. —ii. i' !J--):CC(' p
<br /> YES
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nXYes Qll'o nDon't know
<br /> 2. Is there a wetland or floodplain on or near the property? nYes ❑✓IQo ❑Don't know
<br /> 3. Have you talked with the township about, our,pr. j �d� tt�ee ,t���q� (�ent? [res ❑No
<br /> JJ L1 't�iL)11/�:Jt� f�inNt�t �d�l[l l ill;J� 1i`1
<br /> 4. Has there been a zoning permit issue or this property in the past 5 years? nYes vlo
<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) nYes alo vnt5on't know
<br /> 7. Is this to correct a violation? 2O� 8 NIH nYes [2IGo
<br /> I' ,,-'I la��. APPLICATION MUST BE SIGNED
<br /> �
<br /> REV(01n9 (Continue on Back) —+ —► —0-
<br />
|