Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME -n <br /> Ail IC. o (.' - ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 9 9 6 OA K.1 le d- R, VY!4 rs ket l I lA.) = 5,335"T Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C??0-763-c71,21 9 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A l I e kv W o l ce. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Sarno o-a cc bode.. <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> p Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El N NARCEL MBER 0 d1/ O 1-$`�7�o a Ca.)Al , S. 5 frontage drawn to scale. <br /> U <br /> TOWNSHIP: SEC N: <br /> • YD(k 1h: ME- 1/41/4_ NC ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> -7 C7a3 De4h5u,lte. Rd- filar 51- -11 1,c)S 5355cj ❑ Sanitary permits <br /> CSM: LOT -SUBDIVISION BLOCK/LOT <br /> D (public, private) <br /> S l <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: M 4 <br /> / d,1;4-47+-, -b e x,iss ‘,.. m cc-It:Az s Jed Zoning Dist <br /> This project is a new building ortructure. <br /> • ❑ P 1 9 a (id Uss' <br /> This project is an addition/alteration to an existing building or structure. f 5 <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> C R iral Mdr� ., <br /> nSEWER SEPTIC <br /> (new/ex <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) U A <br /> e,r1:, I I•OWN <br /> t Shortlan (at i nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) o � � <br /> BASEMENT: 1ST FLOOR: <br /> j , TOTAL SQUARE FOOTAGE: 1 L, •, !-'°, r' nCe, <br /> �/�/ 1 . ate) a <br /> 2ND FLOOR: 3RD FLOOR: 4,- <br /> a7ao 3 <br /> lit ...- c �rirey <br /> ESTIMATED CONSTRUCTION COST: and <br /> €I :options: <br /> (Please round to nearest dollar) -s ♦ ♦ -∎ ♦ -∎ $ /2,DOO ; , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [5610 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lo ❑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? re-s ❑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? ❑Yes ❑No <br /> k 25 - 5-7) <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* - <br /> 545-112(4/08) <br />