Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE, <br /> OWNER NAME <br /> i <br /> 0 t <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status;CU ; <br /> Deed Restriction; CSM <br /> ir-1TS3Etil■ ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> _ <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimen <br /> AGENT NAME CONTRACTOR NAME <br /> in Site Plan in luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ c <br /> (City,State,Zip) (City,State,Zip) Setbacks 70//°/ 0 <br /> PHONE PHONE - ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • <br /> '/a: <br /> 1414: ViDriveway permits <br /> ADDRESS: (state,county 0 <br /> CSM: LOT SUBDIVISION BLOCK/LOT S- -ry permits <br /> publi •rivate) <br /> PROPOSED PROJECT INFORMATION s a R ► <br /> PROJECT DESCRIPTION: <br /> 4,i6iii'rig DiS:010 <br /> . ❑This project is a new building or structure. 'Per e" Uses PI Cl This project is an addition/alteration to an existing building or structure. �a <br /> SANITARY SERVICE: PERMIT NUMBER: Rurai ,,i;a li <br /> ❑SEWER ❑SEPTIC (new 1Stin. r <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) s L a� <br /> IV .4 odplal� <br /> AREA TO NEAREST SQUARE FOOT: <br /> §10 1'014 + attachment r,' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .i , <br /> BASEMENT 1ST FLOOR: k, RroslonGontcol permit f <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,distur ance, <br /> fillirr /access' .: <br /> 2ND FLOOR: 3RD FLOOR: g <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ..+ ♦ ♦ and;available°options <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 ❑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) Li Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -♦ —► —► <br />