Laserfiche WebLink
`0 L <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAMF <br /> ..j..‘ ( k �LA.C.e lc_ El Zoning Status; CUP; <br /> OWNER DD ESS (Number Street,City,Stat Zips 0( Deed Restriction;CSM <br /> 1✓ a✓' IIJ— Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 07 - /2 (4-l( .? sure_ k-@ AQ' £OA t ❑ Site Plan raw o scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME <br /> COyRCTOR AME <br /> fq a 1•b,,. 719015 yo ex Laic <br /> ' ❑ Site Plonpcluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well ptic <br /> -7(02.111 ,y 11- It /zoi <br /> (City,.tame,;ip),‘ 01 ��5�2.- (City,State,Zip) ❑ Set( kS <br /> PH`O E PHONE El Site Pia. a+@eV. rom <br /> & d O , .-75- G, /S 0 applica• = is w ip. <br /> E-MAIL ADDRESS -E MAIL ❑ Floor plar�sscale <br /> a, ti ,pis(P--/-ds. � V <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL N( BER: ( , CURRENT ZONING: ACREAGE: ❑ Elevation if irk,- y <br /> ❑ NUMBER 070(J O�4 �� `� – / �, frontage + - a scale. <br /> TOWNSHIP: SECTION: <br /> 1n. %14. ❑ DriveW y $ <br /> ADDRESS: (state, ty,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sani �Iis <br /> 33 o� / (publ iVAe) <br /> PROPOSED PROJECT INFORMATION :.' <br /> PROJECJ[SSpRIPTION: / (,, <br /> 'tJ IC 4-C) cic�t S/?),.,.164_c.0,..,,.,,..; ?tat. C pct <br /> . 1=I This project is a new building or structure. �� <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: AEPTIC PERMIT NUMBER: 0 Rra ° 'nSEWER i ` <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) „, <br /> �i tetia =*i . .pe5cd e� °,1 , <br /> ” m,°�' s el t t^ inert) <br /> AREA TO NEAREST SQUARE FOOT: I, <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> • t 1 tol permit 1ST FLOOR: ? , <br /> j TOTAL SQUARE FOOTAGE: j eta+ Aiiii„? rte. <br /> 2ND FLOOR: 3RD FLOOR: � O <br /> U R W +on Survey <br /> ESTIMATED CONSTRUCTION COST: $ �r� and r ., O <br /> (Please round to nearest dollar) ♦ '♦ --∎ ♦ ♦ ♦ $ l e V(6 i� ` £ =4 5 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes E No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes e No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? El Yes El No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Q 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) EYes fE No El Don't know <br /> 7. Is this to correct a violation? ❑Yes .®No <br /> APPLICAT MUST k BE SIGNED <br /> (Continue on ION Bac ) ♦ -+ <br /> 545-112(4/08) <br />