Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION = CUSTOMER TO PROVIDE <br /> OWNERNAME / <br /> Jc(iol7. esser7)c `Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State, ip <br /> / n /' Deed Restriction; CSM <br /> 4�S C%7 1(Q 11 0/ Pe /"G ���1 GcJ7 3.j Va 'ance(# ) <br /> HOME PHONE CELL PHONE E-MAIL AbDRESS II <br /> 4.4-S7s S7/, a _, egSP h�� © ?no)/ Sit Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION: d includes dimensions <br /> AGENT ME p CONTRAC O NAME <br /> Ld 0 &o / - (1/Po 4 1 CD/ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR QRIl /ESS Of ell/septic <br /> E7 a <br /> (City,State,Zip) (City,Start,Zip) Setbacks / <br /> �a�y�. L , ,/D) ye,,r),, jJ.Z ,3s .� , <br /> PHONE PHONE ❑ 7e Plan -! 'royal from <br /> bej1S- 77 2•v3,7-5" ". !V - '7D in plic.• a township. <br /> E-M/A�ILADDRESS / E-MAILAQDRnES / �-�/ <br /> CA .ear l �clee,., ./�o •/myr f feci '-.'f�i" .ebo'I Lld" Flofir plans to scale <br /> PROPERTY/LOCATION INFORMATION` (httpa/aciessdane.co.danewiusl) <br /> � <br /> PARENT L�MBER: j � CURR: ZO NG: AC 'GE. , evation of property <br /> ❑ PARCEL �t 1 � , d�,0 <br /> rontage drawn to le. <br /> NUMBER <br /> TOWNSHIP: SECT,* //.. <br /> h�so f `, ,/: yy) ❑ Drivewa ermits <br /> ADDRESS: �— • (star ,county,t n) <br /> )fC7\ (A C- a 71Z Sanita r� mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ ' <br /> (pub' ,private) <br /> PROPOSED PROJECT INFORMATION S TAEI REVI 4. <br /> PROJECT DESCRIPTION: <br /> ✓ Y!� ;."'-'7''.- --2.-: "..'''' '...-_,••-•- ;- <br /> tbx-EOx/S Q71/G OZ'/7cf/ S , � i s , <br /> r <br /> This project is a new building or structure. =•❑This project is an addition/alteration to an existing building or structure. >r - ;";--;:':'11'1.--". . <br /> SANITARY SERVICE: ; <br /> ■ ! PERMIT NUMBER: I F 1 <br /> SEWER SEPTIC '1 , <br /> i-,a.., a -dry , r w- : <br /> HEIGHT IN FEET NUMBERIOF STORIES: (Not including basement) -1 T " `A`� <br /> a ;"Ell.. elt an e` °a o <br /> i3DF r, k t7 <br /> AREA TO NEAREST SQUARE FOOT: �� z f -- - ;,' <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) Y <br /> BASEMENT: 1ST FLOOR: <br /> H-- 'x- 10S Oil C o�t o f 0 1 r; <br /> a 1 TOTAL SQUARE FOOTAGE: ,� a _ �30i .'°. Nrs. <br /> 2ND FLOOR: 3RD FLOOR: /�I - c :1 <br /> ESTIMATED CONSTRUCTION COST o c IS o o i~e 4.(Please round to nearest dollar) ♦ ♦ ♦ ♦ - --�-' // 7, �' - ._ --- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes N ❑Don't know <br /> ❑ <br /> 2. Is there a wetland or floodplain on or near the property? Y [ o ❑Don't know <br /> 3. Have you talked with the township about your projct and are they in agreement? EYes ❑ O " <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ✓1No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i one) <br /> 6. Is a location survey required? (see reverse) 1 ❑Yes �J N ❑Don't know <br /> 7. Is this to correcta violation? ❑Yes allo <br /> 4/ /1) S ` APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ --► <br /> 545-112(4/08) <br />