Laserfiche WebLink
Yv <br /> • <br /> Z9NING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> 1.",-L45 GOOK 7018/N eDf3 /v 134ZC>7E • Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> g e& -o?I,r.5 33 ' -/O0 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /y-litiN ---- >. G/LV --/e' 4licil4s,e �pAy rlec Of Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 0130x. 305— <br /> (City,State,Zip) (City,State,Zip) <br /> 4etbacks <br /> Wi44-/A/64A'e 4— WJ 6-3.5.- / 46(PHONE PHONE San approval from <br /> / 06) 7/2 3S-YO applicable township. <br /> E-MAILADDRESS E-MAIL ADD ASS <br /> f6 a Pu«4J i -/ -Z, /veriI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL fr ntage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/4 1 1 Driveway permits <br /> : /a/a: ( ate,county,town) <br /> ADDRESS: �� � <br /> r ` r ` Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION a STAFF REVItEW <br /> PROJECT DESCRIPTION: ' ` <br /> 76'5 f P�,&rc -/ t/oL/5 Zoning District <br /> . ,®This project is a new building or structure. L I Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Q al Address <br /> fecisting) <br /> ❑SEWER `I: -TIC ,l, 3 ;_r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including asement) °y.te6 oreland tt c me t) <br /> AREA TO NEA T SOU F Q T: <br /> (Outside dimensions including unfinished area, attac garages al` bove grade decks or porches) i <br /> on tifittolipermit <br /> BASEMENT: 1ST FLOOR: I o g <br /> /l� �E3 2 /716-- Q5Ab TOTAL SOUA °r/� pesp,,,,,./tun ance, <br /> c5 ✓✓ ` 1 i fillingfas).6d I r { <br /> 2ND FLOOR: 3RD FLOOR: <br /> 7 s/ eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: PS'Z and avaitabie options <br /> (Please round to nearest dollar) -► -► --► -► $ 3 &oi 006 ; . . t i ., ,. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes II No ❑Don't know t �, <br /> 2. Is there a wetland or floodplain on or near the property? 21Yes CI No ❑Don't know f <br /> 3. Have you talked with the township about your project and are they in agreement'? Ei Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes jINo <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 NNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />