Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME -e16-74' <br /> `6 T 4r g 4 An h [t/ Zoning Status;CUP; <br /> OWNER AD RRESS (Number,Str-et,City,State,Zip) 1// / Deed Restriction; CSM <br /> 6O 17 IX V 7 3 ` A�5 4 /I, `' '��3s's 2' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 64g [Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> ApIT NAME CONTRACTOR NAME <br /> a h /8',(`H.a `-\ Sa--7,:o FA Site Plan including location <br /> A TADDREESSS CONTRACTOR ADDRESS of well/septic <br /> /PO hoar c/�m y &- � ` <br /> (City,pate,Zip) ' (City,State,Zip) <br /> Setbacks <br /> G PbAt°v .',P W- SG ,j at M,�/ <br /> PHONE <br /> PHONE Q Site Plan approval from <br /> 60 g ‘9S1-1Z-7 L� S 4 ,t, e applicable township. <br /> E-MAILADDRES E-MAILADDRES <br /> 4 4 UFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �evation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑ NUMBER '0 7/Z..7/$3-ao 9 / 4--/ky yob frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ■ 0-f' Yo k ,/4: ,/4,/; Driveway permits <br /> ADDRESS‘' (state,county,town) <br /> �`3 7 rWy 71 ��" "�// `L/ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION '" �° <br /> / Q STIFF REVI ,.-P '- <br /> PROJECT DE RIP�T�ION: r0I� s, e 7 ‘ /9 -v"� , �-:i; <br /> . ErThis project is a new building or structure. � , <br /> ❑This project is an addition/alteration to an existing building or structure. 5 m -- �� <br /> SANITARY SERVICE: PERMIT NUMBER: ,i, , " l`' ;' <br /> NA (SEWER nsEPTIC t' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) f °°�:N_ A <br /> 'e'iane .0!pia' -�` <br /> z• bore is•attachment) <br /> AREA TO NEAREST SQUARE FOOT: " ' ',1>• <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) � r _; <br /> � a �o))F o e I�+, <br /> BASEMENT: 1ST FLOOR: '::::;;;P-0 i <br /> ,l, TOTAL SQUARE FOOTAGE: j e e rg e e& i�,�. „ <br /> 2ND FLOOR: 3RD FLOOR: s <br /> ESTIMATED CONSTRUCTION COST: --► ♦ ♦ -* -4. --► 0 s' 0, A--,041 V <br /> (Please round to nearest dollar) ��� ��� t"" . ,� ,'` - 4,,' <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 ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? El 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) ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -► <br /> 545-112(4/08) <br /> 4 <br />