Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> ,Z () , <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE ME J <br /> i.-. 13/)//9 Dc7te„t,),,t7 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 30 3/ ed Ral /V✓ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> a 7 9-�z5S/e3 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /'7<e (14/v ,✓k y /7/274e/e,v,v�,gc oar Z/ s ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS/�( of well/septic <br /> S 76 Z.:01/6...e i U <br /> (City,State,Zip) (City,State,Zip), El Setbacks <br /> 5//4, ,e,o..2'? W: s-35- 6 <br /> PHONE PHONE ❑ Site Plan approval from <br /> oc <br /> .3f—/g"‘ ' 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:(http://accessdane.co.daAOCOR.EAWGLEU.S/) <br /> PARCEL 6� O Olo - tot) I R�/ a-053 frontage drawn to scale. <br /> NUMBER tot) <br /> TOWNSHIP: SECTION: <br /> P1/4: 1/41/4: ❑ Driveway permits <br /> ���iS.t�� lZ,n S <br /> ADDRESS: (state,county,town) <br /> 3/C.$ Lc 7 /r/v' <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION Ir„' STAFF EVI " <br /> PROJECT DESCRIPTION: �yr <br /> 2�..r2r/ o?2 'Xad' De-1;9-clzW/-2,Qi7e" -•v,4yz- 1 �� istrigt <br /> ©This project is a new building or structure. .Q <br /> ❑This project is an addition/alteration to an existing building or structure. �� ,D � <br /> SANITARY SERVICE: SEPTIC PERMIT NUMBER: Urat ss a ;, <br /> fSEWER netee ' tiVfiHEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) y <br /> /a U VVes f " 3. <br /> horela1 i - t) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Q erso '. trol " <br /> BASEMENT: 1ST FLOOR: #i,,r,, s ,v' •, a <br /> y�d 4, TOTAL SQUARE FOOTAGE: 4, ,d , <br /> i <br /> 2ND FLOOR: 3RD FLOOR: ego'r.°- <br /> d . Etas 4%� �Survey <br /> ESTIMATED CONSTRUCTION COST: 00 ego ` on <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ "♦ ♦ I I �o " <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. 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? [ Yes ❑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 ❑No ['Don't know <br /> 7. Is this to correct a violation? ['Yes ITho <br /> 3 APPLICATION MUST BE SIGNED♦ --to(Continue on Back) - -* <br /> 545-112(4/08) .l-C <br />