Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME <br /> at vc. aJ S., r 7/0 fir/t1 WA ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 7 3 / s7AI N, N,., ? 5 Edd,-/te, Lvf S 3f 3 V eed Restriction; CSM ) <br /> ariance(# <br /> MEP ON( ? <br /> C L PHONE E-MAIL ADDRES <br /> C CQy • ( Ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT WALE CONTRACTOR NAME <br /> 73 -e '50, I //u el C'd i,f¢ev.t/•.•li ❑ ite Plan including location <br /> AGENT ADDRESS ., CONTRACTOR ADDRESS of well/septic <br /> /, / <br /> ?7 yv /a #olvrucE./ 1. <br /> (City,State,Zip) , (City,State,Zip) Setbacks <br /> PHONF, L, PHONt ❑ Site Plan proval from <br /> . Iica a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> '' RI ' loor plans to scale <br /> 0 0 r 6✓►1.r:/, r e el <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRT Z ING: ACREAG p, <br /> ❑ N 31 Elevation of property <br /> p�J frontage draw o scale. <br /> UMBER Q Oa/A TIj —.�I —1.f oaZQ V� � �- <br /> TOWNSHIP: / SEC O : <br /> L i 4 h 1/4: I J F_ 1/01/0:` ❑ Drivew permits <br /> ADDRESS: (stat ,court ,town) <br /> 3 - S7 . 7< /1_, t, 7 ,t ❑ S.nita permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> .u 'c,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVD <br /> PROJECT DESCRIPTION: <br /> • This project is a new building or structure. <br /> ® P 1 9 l 1 <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: �� ��� F � ,� y <br /> SEWER SEPTIC <br /> ow/ r a M <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> '0°' , <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> E SIionC,rontrot�( <br /> BASEMENT: 1ST FLOOR: �� <br /> 7D e 4, TOTAL SQUARE FOOTAGE: 4, opes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ' 41 <br /> Q Review odattrt e k n <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ d - B1 1• a• �4 <br /> (Please round to nearest dollar) a a I g p p ' zr <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EI,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? NI Yes ❑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 ❑ o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan 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 /> 44. O APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 54&112(4/08) ` <br />