Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofda e.com SUPPLEMENT to Web-App # <br /> r PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME I <br /> tiN rA4r L M k y Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> G 5 n� I \,ct e-, ( ,) eed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6—( 0-1- - Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDR--S f well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> PHONE PHONE ❑\Site n a proval from <br /> applica township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> .Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL _9 -J— CURREj1TZONING: ACREAGE: frontage drawn to scale. <br /> PARCEL ( (�'lC // 31-1 <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> •1, `''J (,-) r t 1�: 1.1 i�� 1414: ❑ Drive ay mits <br /> ADDRESS: 1 tV (state unty,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanita •- m <br /> (pus ' , pn, -te) <br /> PROPOSED PROJECT INFORMATION STAFF RE IIEVI <br /> PROJECT DESCRIPTION: s E " <br /> J �� DP ;w c �Zaning ,1!. , <br /> . JiitThis project is a new building or structure. ermitted Uses; <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NIJM / F� "' <br /> ❑SEWER ySEPTIC �I r (fl /exISt[n® gz <br /> HEIGHT IN FE C NUMBER O S RIES: (Not including basement) l L . '� <br /> I $ho s ,sattah i/�t- <br /> Sho a , 7(a:4$006 it <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) k 9 <br /> BASEMENT: 1ST FLOOR: ,'"..;"44...'1,:,ECa9 ° ' �� �� tA3 <br /> as <br /> 4, TOTAL SQUARE FOOTAGE: 4, ( p ®Isturba� <br /> fil; g!acc ,a�� Ea <br /> 2ND FLOOR: 3RD FLOOR: 3 <br /> 3, C <br /> ESTIMATED CONSTRUCTION COST: QReV1eW attOl1 SUrvey <br /> (Please round to nearest dollar) -"∎ ♦ "∎ '∎ '♦ ♦ $ � I c i i and lla aptlans `_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? eyes ❑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? ❑Yes kiNlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? UYes J4'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 to ❑Don't know <br /> 7. Is this to correct a violation? es ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />