Laserfiche WebLink
• . <br /> SUPPLEMENT to WetrAPP # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> • <br /> PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE <br /> ammo i • <br /> ' a G L_Le_ <br /> _ .... t A at ke 0 Zon big statu 5;CUP; <br /> • .---.. ...., , (Numbir,- M.. . ,.) Deed Rstriction;csm <br /> a . ..Iiil 1W Jut • , ■.t. .A.1-1 321 Variance <br /> CELL PHONE E4dAILADORESS <br /> E4 it., I ct 0 Site Plan drawn to scale <br /> AGENT INFORMATION !CONTRACTOR INFORMATION and indudes dimensions <br /> CONTRACTOR NAME <br /> L/ <br /> 1 <br /> 1.1) <br /> *di mi, 0 Site Plan includin9 location <br /> AGENTADCRESS CONTRACTOR ADDRESS of wellisepdc <br /> (Cay.Oulte.V43) (cIty.BMW ZIP) 0 Setbadcs . . <br /> PHONE PHONE . 0 Site Plan approval from <br /> applicable tOWI1ShiP; <br /> EMAILADDRESS E440AILADDRESS L3 Floor plans to scale <br /> PROPERTY1LOCATION INFORMATION (http: accessdane.co.dane.vvi.usi) CI Elevation of propertY <br /> PARENT PARCEL NUMBER: <br /> 3 PMCE!.. _ () )/) ; as , P 0 e' si <br /> ... • frontage drawn I0 scale. <br /> TOWNSHP: . SECTION:t 0 Driveway permits <br /> lA- 4: , YY:__ <br /> (state.county,town) <br /> ADDRESS: Lidi-i-?-CC 0 Sanitary Permits <br /> MA: LOT - • • IL.i 1 BLOCIOLDT (public,private) <br /> I 1--• <br /> I b 1 0 . ii , <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: S v...__ Qv) e eili utii <br /> • III s project Is a new building or structure. <br /> • <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> 0 SEWER °SEPTIC <br /> HEIGHT IN FEET 0 ik • / 9 NUMBER°MORES: 1 . Including Imsornent) <br /> 0 4" riff.a.- • <br /> AREA TO NEAREST SQUARE Foor. <br /> (Outside dimensions including Unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FL•• <br /> ;,;,, <br /> tO 10 / R1\ 4 TOM.SQUARE FOOTAGE: 4, <br /> /6 / 3RD FLOOR <br /> ' 1 6 IOW g S C14;( <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest data) -■ -■ -* -■ -* -* $ Aq9 if op <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0Yes t12‘ C:1 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes Ciao 1:3 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ifftes 0 ,No <br /> 4. Has there been a zoning permit issued for this property lithe past 5 years?... 0 Yes IR* <br /> 5. Is this project associated with a rezone/CUPNariance(petition/aPpeal ft ____i (Mee blank If none) <br /> 5. Is a location survey required? (see reverse) ( 'Yes 0 C3 DOM know <br /> 7. 18 this to correct a violation? L3Yes UN° <br /> #SA IA- 3 D APPUC.ATION MUSWT BE SIGNED <br /> (Continue on Beek) <br />