Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME _ <br /> re * /)v nn o.- f- re_ Th' ' ' Lt C <br /> OWNERADDRESS jNumber, treet,City,State,Zip) y ❑ Zoning Status;CUP; <br /> Sg I( w r 6 •n e rp 4o�r 'J !N� 53, 9C Deed Restriction; CSM <br /> y ,l Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME f ,, CONTRACTOR NAME <br /> To 5`-- k- er ' ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7-299 3,6 C ii_IAN'c.) S-/" <br /> (City,State,Z ) (City,State,Zip) ❑ Setbacks <br /> Co �,< 4rd ye !'VLSj.S2 <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/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZO ING: ACREAGE <br /> ❑ PARCEL <br /> frontage drawn to scale. <br /> NUMBER 06//0 Z j 9"°i - �� L1 r <br /> TOWNSHIP: <br /> SECTION: <br /> Dl€Rf4,,1,7.- S"p r.' j f Z 1/4. 1/41/4. ❑ Driveway permits <br /> ADDRESS: 1 �! / ✓ (state,county,town) <br /> ZD S e A "•• ei'l Pd <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> • "---- �._ 1----- (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF ;l' E <br /> PROJECT DESCRPTI . I <br /> Y"F c <br /> rar44y Scar' s� o'' br'l`-c/ C Zoning Dist ct <br /> . ❑This project is a new building or structure. U P' r Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: �-Ru ddre <br /> f SEWER j29SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ------^ ,-------- El w.3 gFi s a 5i 3 <br /> AREA TO NEAREST SQUARE FOOT: r Chrt1Clt <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �,-: <br /> BASEMENT 1ST FLOOR: <br /> `.— N` 4, TOTAL SQUARE FOOTAGE: 4, (slopes, . <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> t L.Ocation Survey <br /> ESTIMATED CONSTRUCTION COST: an �0 <br /> (Please round to nearest dollar) ♦ ♦ "♦ '♦ ♦ '-- <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 N'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) es 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 />