Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME � <br /> Ti '' i ' L !/y <br /> 6h ZL I ❑ Zoning Status; CUP; <br /> OWNER AD (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> m '9 Or .d lc Vacs S✓� �rH�'r c ►.vT �3S9�I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6OS'-2o4- (4.30 1r ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACT,p R NAME <br /> � <br /> ' N Yc 01 S 1-5'S <br /> '� ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> YO Box it1(10 <br /> (City,State,Zip) (City, n State,Zip) - ❑ Setbacks <br /> )he11.-c/(c/ W.1-. 5 ' `� <br /> PHONE PHONE ❑ Site Plan approval from <br /> (a!1 g go 701 4 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r h cr4 sI( C w ' OOd 1 s cp.,.� ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑ PARCEL �a X03 Old p —1 Q frontage drawn to scale. <br /> NUMBEELR <br /> TOWNSHIP:C�� 4 'r►/r z7c SECTION: <br /> �J/// <br /> .1/4: ,/,/4: El Driveway permits <br /> ADDRESS: (state,county,town) <br /> �d /3r,i� PASS <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ` TAFF EVIEW <br /> PROJECT DESCRIPTION: 1 4r <br /> 10 X 4 Li I n Ito✓^' P o O I .® lft o CIS C��. , <br /> . 2-This project is a new building or structure. - I' se? , <br /> EI This project is an addition/alteration to an existing building or structure. . . ,i ff ' 7- <br /> ' ®*ress <br /> SANITARY SERVICE: PERMIT NUMBER: , z� 4�;- '' <br /> SEWER EPTIC ne e g) � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '' �,° s <br /> e, ss p <br /> AREA TO NEAREST SQUARE FOOT: 6 -a � inQ11 �` <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) i �' <br /> BASEMENT: 1ST FLOOR: EIn� ' (3t_`peflrll. <br /> U <br /> 4, TOTAL SQUARE FOOTAGE: a• • <br /> 2ND FLOOR: 3RD FLOOR: , , -. <br /> ♦��/� <br /> ®v- ey <br /> ESTIMATED CONSTRUCTION COST: $ co • a. o e • <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ a; <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 El 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 II.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) -0 ■ -■ <br /> 545-112(4/08) <br />