Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Sum eaor‘ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS,(N,umber,Street,City, te,Zip) ^ Deed Restriction; CSM <br /> /7�9 % �/aw►..5.‘ <br /> '� �� / W�- ���� Variance(# ) <br /> HOME PHONE CELL PHONE ?MAIL ADD ESS <br /> Coi -0 73— ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C NTRACTQR NrrE /J <br /> QN o/ (/oJiLS>'r�•c�,o,,. ❑ Site Plan including location <br /> AGENT ADDRESS C NTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE 8441^i �l � <br /> PHO ✓ � G� ❑ Site Plan approval from <br /> �� -°� 7 l - /� I ( applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> iCEL <br /> ar/� ®1 7crl 's)ik'fa�-1R, <br /> d ti' ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http J/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE ❑ Elevation of property <br /> ❑ NUMBER ap ii -3aa-$53p-o Imo--' /. 30 frontage drawn to scale. <br /> TOWNSHIP. SECTION: <br /> asa,. %rill 5 �v 1h. 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> brg <br /> csM/ 7-9 /.l III,a'L)T 5-6'5 SU4 vISION BLOCK/LOT ❑ itary permits <br /> 94/3/ / (puSanblic,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: y, - R <br /> �� � <br /> O✓V �„(4, t9 r <br /> ❑This project is a new building or structure. <br /> '''- ir - 1 <br /> // <br /> [This project is an addition/alteration to an existing building or structure. /, <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> SEWER I1SEPTIC n ? � <br /> „,, �/ / r. <br /> HEIGHT IN F ET: 3 1 6/, NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)BASEMENT: 1ST FLOOR: °` 0 e /a 0 + TOTAL SQUARE FOOTAGE: 4 i <br /> 2ND FLOOR: 3RD FLOOR: `@ <br /> 70� <br /> >� .-. �� <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ --► � _ ' • / <br /> (Please round to nearest dollar) $3q,�. ��1l/. 1a <br /> f <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? <br /> DYes �No <br /> A(Continue PPLICATION on Back)MUST BE SIGN ED <br /> 545-112(4/08) <br />