Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> r �P i '720'r/0 /G '/!?� ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> `�z. ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT A E CONTRACTOR NAME <br /> � r1/L � p>/ % , 5G,./07-2e,, Site Plan including location <br /> A ENTAIRESS3�r�i�<„ A CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zi en 6��(City,State,Zip) Setbacks <br /> 7 '--*" <br /> PHONE PHONE ❑ Site Plan approval from <br /> �—rr71'0 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ,/e ei7>4C / 81-S���7 <br /> 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 /> NUM ER OW 31q /7i b V--j A- 1.,c5" frontage drawn to scale. <br /> TOWNSHIP: l , SECTION: <br /> /� /'� 1/4: %IA: Driveway permits <br /> ADDRESS: '����'i r r / f / (state,county,town) <br /> 4,- ` 91 Li ( 11,WW 1 OVkS Tt,4,1 El Sanita <br /> CSM: LOT SUBDIVISIt BLOCK/LOT (publi• private) <br /> PROPOSED PROJECT INFORMATION <br /> re t OFF`:REVI <br /> PROJECT DESCRIPTION: <br /> L9134re, S-PR. �" + ►' �� � e <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: °L1,i' ,;,! s s <br /> SEWER SEPTIC <br /> t � ' <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) $ <br /> � r2'"., ,etlan a ,,t®rya. ' <br /> x R -nt <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) g, ,4 t • - Q ° ° ,,: <br /> BASEMENT: / 1ST FL R: _ ; <br /> Z2 C%� �j! I Z)L� 4, TOTAL SQUARE FOOTAGE: j 1,:t.'s o s a <br /> / <br /> 2ND FLOOR: // 3RD FLOG ` - <br /> l/� ��)�+° 'e r <br /> ss� s <br /> ESTIMATED CONSTRUCTION COST: • .,g i <br /> $ ,I s¢i. ,._pp,(Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �V 71 ... <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes flo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ErNo 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 1Yes ❑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#6. S ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes lallo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> ' ' 41) 1_ 50 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -o -0 <br /> 545-112(4/08) <br />