Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> CJ,c r i r 3 1-1c-t k.! -f---,,)4t., (7c k 4 1=c.-ti1 I y "7`r Li)71: ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 3 Deed Restriction; CSM <br /> do t,vc"f RA fv yorc LA,1 J S 7a Variance ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60(3 ?b 33 L G ht '/I'/ . 40 L_CO"'I ❑ 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) ❑ Setbacks <br /> PHONE PHONE ❑ 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 /> ❑ PARCEL O�D >D,Db ` `� ,�1 Z frontage drawn to scale. <br /> NUMBER / -eR- <br /> TOWNSHIP: SECTION: <br /> �c«,,,o�-} ,/4: ,�4,�4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: yn <br /> - 5±o re $ " 20?o Pt- _ ,District`; <br /> LThis project is a new building or structure. a permitted Use's <br /> ❑This project is an addition/alteration to an existing building or structure. ' �5' <br /> SANITARY SERVICE: PERMIT NUMBER: tykii r Viel.; ass <br /> n %; <br /> SEWER n � <br /> SEPTIC ��'`,i3 E y� ere,',` <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /y e"S^r9t1 ,.11s 1 t We tModanl <br /> AREA TO NEAREST SQUARE FOOT: {�i l 1° <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: � �. <br /> 2v!v j TOTAL SQUARE FOOTAGE: 4, �� 0 dlrbtc <br /> fllfin+ es; ) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: � ���� �� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ DOO r�lB�03t[tirlS' <br /> 2©, , A* Hoer <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [l •No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? El Yes u No ❑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? ❑Yes ®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 ® No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />