Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAMEA � �1v! <br /> /('11 y Zoning Status;CUP; L'Z <br /> OWNER ADDRE S m er,Str et,City State,,,,Zip) // t- Deed Restriction;CSM <br /> i513 S G p( 7 `-I • . 14 J J 357 Z Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI}4DDRESS <br /> 1137 `f L/O 1,) L-D7SO I r1 $,l?M I.S1■l11'ti.>wie5,Cow• ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAM CONTRACTOR NAME L <br /> SCE, ❑ Site P uding location <br /> AGENT AD RESS CONTRACTOR ADDRESS of WellPse C <br /> cx',RI2E c� <br /> (City,State,Zip) (City,State,Zip) ❑ S• etbacks IC`?,04,�5 <br /> PHONE PHONE NE S• ite Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor ply scale <br /> t3 �T' <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) .• <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property O T <br /> ❑ NARMCBEEL R d be) - -12--1 _gag�-D frontage drawn to scale.'?� . <br /> TOWNSHIP: SECTION: <br /> give. Hpa„oQ '/4: 1/41/4: Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> I 0 O r <br /> CSM: 1-13 LOT f9 l'. y RR BDIVI� S• anitary permits N BLOCK/LOT <br /> (public,private) iA <br /> PROPOSED PROJECT INFORMATION 7 1 <br /> ita Ew <br /> PROJECT DESCRIPTION: <br /> . ®.This project is a new building or tructure. Up ` ' U� <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U RuralA€d <br /> [1SEWER nSEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> k $ a o,l ailit <br /> s a € ; <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: f:; <br /> j TOTAL SQUARE FOOTAGE: ,, . + °' + • , oy <br /> P <br /> 2ND FLOOR: 3RD FLOOR: , ,„ -',. <br /> Location Locati91,1urveY <br /> ESTIMATED CONSTRUCTION COST: -� i ' 8 . <br /> (Please round to nearest dollar) ♦ ♦ '♦ ♦ ♦ ♦ t C ' !:. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes p 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? Dyes ❑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? Dyes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -0 -► <br /> 545-112(4/08) <br />