Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O ER ME ff JJ <br /> n�`- n l , may- 'Ma ❑Zoning Status; CUP; <br /> OWNER ADDRESS- umber,Street,City,State,Zip) Deed Restriction;trSM,, <br /> HOME PHONE O`� CELL PHONE Ras OEM ADDRESS\iv( - S--/J Variance(# ' ,.,',;,% .y,j <br /> (1.)(YE, $13-Se18 Coo$ 532- r.1 O4.4-+d0 0Ys 2 w 3 rrc&.1 . Ga n^ ©Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ©Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) IN Setbacks <br /> PHONE PHONE E Site Plan approval from <br /> 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: CURRENT ZONING: ACREAGE: <br /> El NUMBER 051 frontage drawn to scale. <br /> /0510-223- g500� A' I (Ex 25 (o g <br /> TOWNSHIP: SECTION: <br /> Friufl0.nel 21_ 1/4:SE. aFtt 4%: SW El Driveway permits <br /> ADDRESS: (state,county,town) <br /> 38(0B old Q-6 n>Z. Izl Qrcoto r , Irv ) S 3S1 S ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 3800 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , ' <br /> 1O'xI(p' cecJ<- 3©x fie.' 3 Season porc1n 'U 2, " r <br /> . ❑This project is a new building or structure. �. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: D $S <br /> HEWER OEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I Z 0 n$2_, ) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> % I' O 5 "c4- j TOTAL SQUARE FOOTAGE: + ( et.. <br /> 2ND FLOOR: 3RD FLOOR: <br /> ( 4O' 3• -C1- . 'URe i <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) -► ♦ '♦ ♦ ♦ 0000 • DO <br /> , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eres DVo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes alo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Wes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑1'es Elo <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 Bo ❑Don't know <br /> 7. Is this to correct a violation? Elves o <br /> 1.-A5( APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -* <br /> 545112(4/08) <br />