|
SUPPLEMENT to Web-App #
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Sc_ti"'e.ays S 0C,/ts k Z--LC ❑ Zoning Status;CUP;
<br /> O NERADDRESS (Number,Street,City,Stag Zip) Deed Restriction; CSM
<br /> IAD 2Px (02-030 inradt-cfc ,•■. i ---'-)� . SS--,. 2 -030S Variance(# )
<br /> HOME PHONE CELL PHONE E-MAILADDRESS
<br /> (4s--3S-`f I Sy t •"'' @ -Pi '-6
<br /> - Site Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME �-
<br /> /-},,,-,. U..1 1V5 ose �c��-s-,w�cT<,—,, ❑ Site Plan including location
<br /> AGENT ADDRESS Co �J CONTRACTORADDRESS ', f� of well/septic•
<br /> (City,0-): (c.11)2.1-1,,,_) �.c -- 3�S (City,i.`State,c t .�t� -5 ❑ Setbacks
<br /> PHONE PHONE ❑ Site Plan approval from
<br /> (¢(X 5'-3 - LH S-"/ Ca O5-- Sc,,,-°)(o D I applicable township.
<br /> E-MAILADDRESS E-MAIL ADDRESS '
<br /> J'� e SI-0 -1^'`'-4 L)_.)%M e r a it , N'I 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 NUMBER (-9C50, - ``)`/(40 C - Z 3.`7 q -1-1 frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> "."0..—i---, , C- R.-1 d , S.. 1/4: 1/41/4: ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> Cps CSM: B tom( LOT , ` SUBDIVISION 1 BLOCK/LOT El (public, permits
<br /> (public,private)
<br /> PROPOSED PROJECT INFORMATION 0'
<br /> PROJECT D SCRIPTION: —it*
<br /> s �� e.
<br /> , � oo .. I . , as
<br /> S iu /�r,'/�. .---1,--e-L,,,-.1..„ ICS " .,s
<br /> '� - try" ' °,
<br /> . ®This project is a new building or structure. r r: as:,
<br /> ❑This project is an addition/alteration to an existing building or structure. '`
<br /> SANITARY SERVICE: A_,.0^--8.- PERMIT NUMBER: 5 °
<br /> nSEWER nSEPTIC ° . "" - ;4
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) d s
<br /> t.Co 1
<br /> AREA TO NEAREST SQUARE FOOT: ��h "° r
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> ' . �. °
<br /> BASEMENT: 1ST FLOOR:
<br /> +-- l f '130 j, TOTAL SQUARE FOOTAGE 4, °° ° ° -
<br /> ° rte.
<br /> 2ND FLOOR: 3RD FLOOR: 74i.*::' �
<br /> 119. 0
<br /> € - .,y
<br /> ESTIMATED CONSTRUCTION COST: (� p a .�,, ° .€.
<br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ f�/ �' :.'0--,7,4744*--
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Yes © No El Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? fl 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) ❑Yes ❑No ©Don't know
<br /> 7. Is this to correct a violation? ❑Yes © No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -i -►
<br /> 545-112(4/08)
<br />
|