Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME /� <br /> / 7/ M �a<�G-�,6J1v , XZoning Status; CUP; P►/ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7 2 /-Ht., 7 3$ s' f- it-'/ 5"3 s 89 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS /J <br /> Z� 875-‘,---c54(� g 77-/f oh-- �FM Site Plan drawn to scale /1/C <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions ,ekt Ap <br /> AGENT NAME CONTRACTOR NAME <br /> ASite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS r� of well/septic ©������ <br /> (City,State,Zip) (City,State,Zip) L�/�I Setbacks I <br /> PHONE PHONE ViSite Plan approval from A p <br /> applicable township. iv <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> [2(fElevation of property P L NUMBE�( Q I� CURR ZONING ACREA Q� p operty <br /> ❑ NUMBER 3,ij �V/�/3 w^ ^ 1-� �(J rontage drawn to scale. <br /> TOWNSHIP: t SECTI ' <br /> V �►- /(i r' K �s, 1/4: 1/41/4: S I ,/i �:_ ay permits <br /> ADDRESS: aunty,town) <br /> 2l 7___ / / 3 S , ' Sanita: •- ii its <br /> CSM / LOT SUBDIVISION BLOCK/LOT (publi • �� <br /> PROPOSED PROJECT INFORMATION s <br /> PROJECT DESCRIPTION: A 6"' ,[,� / D STArF y <br /> his project is a new building or structure. , � �, 1 '�� <br /> ❑This project is an addition/alteration to an existing building or structure. , <br /> PERMIT NUMBER: <br /> � <br /> SANITARY SERVICE: .;a � �,,' 4!' ..,, ' ig it <br /> ri SEWER /'SEPTIC ri <br /> • <br /> HEIGHT IN FEET: ` NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: h `� ¢ ( € 4 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ', <br /> BASEMENT: 1ST FLOOR r� (+ • <br /> �� 4, TOTAL SQUARE FOOTAGE: 4, (, •0//-'-'' <br /> -,distur nce,' �� <br /> •� � A '/ <br /> 2ND FLOOR: 3RD FLOOR:. 3C �O 41010 <br /> 14 ffi eview SUr i <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ...+ ♦ ♦ ♦ $ Pp 6 0 00 eop�� <br /> (Please round to nearest dollar) yt ; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes r No El Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0-No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 11 Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# Li a `1 1 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) DYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes D No <br /> AICA MUST BE ED <br /> 545-112(4/08) <br /> (Continue PPL on TION Back) -► ♦SIGN-► <br />