Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME �--�� <br /> V°Isbs 3e1Sba-Ot ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> ab4 M1to C �..Lk" Qa . i(trti,p u.s, sys Deed Variance Restriction; CSM <br /> � dw-� � t , °l3 Variance(# ) <br /> HOME PHONE L CELL PHONE E-MAIL ADDRESS <br /> (fig %;y� 'II C3 (al? tic — t °' .uAS a b.e&rtcrt.kc`c.,..-■a�c`c -1...cM ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> W Y—SLOB 4-. S ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> F'�. i ,Pen w,. S3s"4-Z <br /> PHONE PHONE / ❑Site Plan approval from <br /> long — 4-31- -i t.L 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: CURRENTZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER O(oo� - a�a- qut -a i - (o <br /> TOWNSHIP: SECTION: 3(. —(o- } <br /> Q/t \-0- tJK,A IA: 0,4j %IA: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> pp B Serf„c`olGQ,. G,,,�cr cg-b, <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> Fp .A,i iLooe. Tc96 L-f�oiJ <br /> ❑This project is a new building or structure. ( ..dam ” <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 13, ° , <br /> EWER {EPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Cc• <br /> U l c, lane l�n/ <br /> AREA TO NEAREST SQUARE FOOT: * Itt .' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a .-.,, <br /> BASEMENT: 1ST FLOOR: <br /> if 4, TOTAL SQUARE FOOTAGE: ,, , _, , <br /> 2ND FLOOR: 3RD FLOOR: �} <br /> ESTIMATED CONSTRUCTION COST: ��w�+�` <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EirJo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? rl]Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ,Q 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 Flo ❑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 />