Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> �: NC r-- �'\k‘ S e ngng Status;CUP; <br /> OWNER ADDRESS (Number,Str> to ity,State,Zi ` Deed Restriction; CSM <br /> ar) on N \ 1n`e. du,�C� � Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRES d� <br /> •-.. .40// 6o '; • ) ip a eNt AD fit Lit ve Ca f Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> EI)Sit(1";including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State, ip) etbacks <br /> PHONE PHONE ❑ Site a royal from <br /> app'c ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> o-o plans to cafe <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONI G: ACREAGE: property <br /> ❑ PARCEL --7-6— <br /> +6— frontage drawn to scale. <br /> NUM R �C�� 093�Gtoq <br /> TOWNS IP SE C 1 ' <br /> R:t y� C\ 1A. v V1/ %,A. Dri a ermits Co <br /> ADDRESS: UI 11// (s at unty,tow�'>✓ <br /> . i� C . 6 .1 Al>>Nk 0 "1 Sa,� •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT S il: l• private)s�n <br /> �J .0 <br /> a <br /> PROPOSED PROJECT INFORMATION AFF REVIE‘ <br /> P JEC� D SCRIPTION: <br /> itc,aq OL feu) S C_V• e, (I) 3 , . , In'DIs` <br /> �� - r' f9 <br /> This project is a new building or str cture. Med Usi�?' <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT N M ER: » 5 F x ` r ...,%, <br /> (ij 'P` XI3Stin' <br /> 1 <br /> nSEWER 'SEPTIC <br /> HEIGHT IN FEET: ' ,\ NUM/ER OF ST IES: (Not including basement) <br /> + '(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) E '1;,-',''::„, + + t - <br /> BASEMENT: 1ST FLOOR: <br /> Z O 0-11S0 /Tp� j TOTAL SQUARE FOOTAGE: ( ++0 isturban , <br /> 2ND FLOOR: 3RD FLOOR: N:.:. <br /> CS n IN Review ... + Survey <br /> ESTIMATED C NSTRUCTION COST: 2,//(- iii s ,+ t `s+ . <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ K <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes a,No ❑Don't know° <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes MINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ' Yes IN No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1E.klo <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) DYes a"No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes la No <br /> APPLICATION S BE SIGNED <br /> (Continue on BacMUk)T <br /> 545112(4/08) <br />