Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW R NAME <br /> /OA(-14$ r ArfiA.) 5—uree.il0 ) ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> of n! 6 l w y i y /3 rat)k'/'1:7-1 n) w i) S-3 f 2 / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> tot S 0. 6 u 9 S h ( ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL U S'l d-..Z�'J3-7 /13r. 6 ,4 I i' Co frontage drawn to scale. <br /> NUMBER <br /> TOW HIP: SECTION: <br /> if(CI t t9 hd a 5 1/4: ,/1/4_ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ;150 Ilwy / ci 13rsuuki,7nl w() .312 / <br /> ❑ <br /> CSM: LOT gUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PRRJECT DESCRIPTION: • <br /> / <br /> 44)41;v11 4..Ayy L( v..t 5-h c k ,S . ifcOt 1 f 13,ZankigE,Ittistlict" <br /> This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: '° <br /> fSEWER [SEPTIC (n�estir!9)� <br /> HEIGHT IN FEET: NUMBft OF STORIES: (Not including basement) �� �:i a <br /> Shares ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ---- ----- _.__ A •A,,t<E e'er' , , <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: j 'disban <br /> turce, , <br /> 2ND FLOOR: 3RD FLOOR: <br /> 60 i ,0 7:1.":-,r;,,-,,.;',.: 7,i' , : <br /> ESTIMATED CONSTRUCTION COST: t V <br /> (Please round to nearest dollar) —0. —0. —10 —0. —0. —0. $ v S U' v u ,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes UtNo ❑Don't know <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? EtYes fl No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <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 2I■o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />