Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1� ,pp � �. <br /> °I-,.eve `-` , 0 ❑ Zoning Status; CUP; <br /> OWNER ADDRESS(((��Number,stye C tate,Zip) Deed Restriction; CSM <br /> t!�oe -P0 - �S AV2 3(Q Y)'` lTr0 <br /> Le)1- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD SS <br /> f00$ -3�[5-(3O ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME Cp.,ITRACTOR NAME <br /> (m, V ils�e�S ILA C- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR A RESS ,-- of well/septic <br /> (City,State,Zip) (City�State,(--((--(i) U El Setbacks <br /> r1/.44)150K) W I 5 7641 <br /> ❑ <br /> PHONE PHON Site Plan approval from <br /> (p 0�—a z-f£( '3y L(C) applicable township. <br /> E-MAIL ADDRESS E-M I ADDR ESS <br /> Grit(4) i-1�E�-SC c moo •Cow' ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> El PARENT PARCEL NUMBER: CURRENT ZONING. A/C�,REAGE: [� El Elevation of property <br /> NUMBER © . 10 -V S I -a. - < tJ`1 V- - B <br /> frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 6� VY1 t 6,Vo v 1/4: 1/41/4; ❑ Driveway permits <br /> ADDESS: (state,county,town) <br /> (o OD- Pcweys AV <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION t 4 <br /> PROJECT DESCRIPTION: <br /> aO I X 30' 6 4E-0 • <br /> This project is a new building or structure. et" <br /> • ?� Us,? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVIC PERMIT NUMBER: Add r' <br /> SEWER nSEPTIC (neW ► ! <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4, <br /> I .f 4 OWe� e 1% <br /> AREA TO NEAREST SQUARE FOOT: 51 *4"w.%:` <br /> -7 r <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) o <br /> BASEMENT: 1ST FLOOR: £ � <br /> j TOTAL SQUARE FOOTAGE: , fit n ) <br /> n. :I: h Ibance,' <br /> 2ND FLOOR: 3RD FLOOR: <br /> 7 ao <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ ♦ '� ♦ '� l� r5�� ,`� ` � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes d ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Eyes 1lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yeslo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank' none) <br /> 6. Is a location survey required? (see reverse) Eyes gNo ❑Don't know <br /> 7. Is this to correct a violation? Eyes I "No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -+ <br />