Laserfiche WebLink
. ca, t_po rl . <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1r C <br /> ' ' C ` ; t g (711 0 Zone • Status' -0 <br /> wo (N umber. Cloy,=, •. t o Deed i i ;CSM <br /> 0 t <br /> / s D • <br /> b , %I . IA LLI its Va • (#------) <br /> OME PHONE CELL PHONE E.MALADDRESS <br /> e .-3(00 0 Site Plan firs .to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and indu dimensions <br /> AGENT ,I, I d V .�, . CONTRACTOR NAME 0 Site P o i uding location . <br /> e .. S (/ CONTRACTOR ADORERS of MR <br /> • <br /> (City.Sts Zip) (CI Iy,SbtWa,zip) 0 <br /> • <br /> PHONE • 0 Sits Plan a' -t i •m <br /> :PHONE applicable Vcale••E-MAILAODRERS E.MAILADORESS ❑ plans <br /> PROPERTY LOCATION INFORMATION (http:'accessdane.co.dane.wi.us') 0 Elevation , • •' 4 <br /> ❑ PAREwr PARCEL • 4 t a CURRENT/3i., <: ACREAGE: frontage d :,4., to scale. <br /> AN <br /> TOWNSHIP SECTION: `. 11: <br /> �� ' : _ 1414: (state, • • ) <br /> ADDRESS: c.) , . <br /> /V • a 1 I 16.2 1..`� ❑See tart'Permits <br /> CSM: LOT SUSCIVISION BLOCKILOT tp•+!kw' ' <br /> 1 D ' A("'Ll-Le_rv41(.)w <br /> - PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: t <br /> SI e s •• ' L <br /> . ti Is project is a new building or structure. <br /> 0 This project is an addition/a tion to an existing building or structure. <br /> SNJITARY SERVICE: <br /> 0 SEWER SIC — j • <br /> SEPTIC J� — v V I a <br /> HEIGHT IN FEET. 4, . OF STORIES: ( kS bs 4/ <br /> • <br /> AREA TO N ST SQUARE FOOT. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 4,1 ST FLOOR: A 2:2,• + TOTAL SQUARE FOOTAGE: <br /> 0 .04160 <br /> 2ND -c 4 1 FLOOR. 937 b <br /> ESTIMATED CONSTR • COST: -► -► -4• -s• -► -► j ' Co <br /> (Please round to neared dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑ No ❑ •t know <br /> your project and are they in agreement? lyYes 0 • <br /> 3. Have you talked with the township about yo proj Y <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0Yes ,'% No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal ii ) (leave blank one) <br /> 6. Is a location survey required? (see reverse) eG — ❑Yes a Don't know <br /> 7. <br /> Is this to correct a violation? ❑Yes No <br /> o APPLICATION on Back) -' "-• <br /> (C -• <br /> 545.112(4105) <br />