Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER LAME <br /> n tri �A/ oning Status; CUP; <br /> OWN R DD S (Numb r,"SFr, City, ate,Zip) <br /> 5-35V Deed Restriction; CSM <br /> Z L ��r/L�ii%5.��� �1J ././7 � Variance(# ) <br /> HOME PHONE CELL HONE E-19 <br /> ,. 0 ZO-5"Zze 54L-41 e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Mi57-V�S�r�o�. uu i ❑ Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State, ip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> �_ z_ OnS t; ? applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MI oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vation of prop <br /> e <br /> PARENT PARCEL NUMBER: CU ENT ZONING: ACREAGE: p p <br /> ElPARCEL �� _' (s6. O frontage drawn to scale. <br /> NUMBER pe�� --/z51-66-212 `� <br /> TOWNSHIP: SECTI N: _ <br /> �-7�r�, 1 '/4: s '/a'/4: wa ermits <br /> ADDRESS �� Y� YcY/'r� (sta , unty,town) <br /> "Z l p y `1 1/8 ii: ' p, its <br /> CSM: OT SUBDIVISION BLOCK/LOT (publi . 'vate) �/ <br /> _ 'e4erJ k--.)q clib 1! <br /> PROPOSED PROJECT INFORMATION y 4- <br /> PROJECT DESCRIPTION: <br /> . ❑This project is a new building or structure. <br /> / _h i ate' '. <br /> liThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: �r� .° Z <br /> nSEWER nsEPTIC �' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) _ �`� �;,...,%' <br /> ..etfie'L 11 ) ,y ) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: i <br /> ° C s+ TOTAL SQUARE FOOTAGE: j K s y a 5 <br /> 3.?-,-(e) v <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 'tir �a <br /> ESTIMATED CONSTRUCTION COST: Wit( ''. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ C,(, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes �No ❑Don't know PO <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑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 ,I∎ 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 lo , ],Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -♦ <br /> 545-112(4/08) <br />