Laserfiche WebLink
I <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA E \<,I 22-3V <br /> �'c�n t( n 1 Pi) c hG nix bra Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3c5 O►ctS( c kd. Pj(C(;kl r NI 5 `S.). ) <br /> HOME PHONE CELL PHON� MAILADDRESS 4 <br /> %G x`15-�i45 ,boy)5'15-11.45 eDDR c.yy 3 tC 3bccIobnl, net tils b Site Plan drawn to scale ii <br /> AGENT INFORMATION �CONTRACTOR INFORMATION a • e__.._.:,:,;..��.. s_ <br /> AG NT NAME n CONTRACTOR NAME �� <br /> . 1 a t t RC f. % Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of rrocH/scptie <br /> .43 fcrkt cin 1 VI 5 35 a-1 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> 3lti 510tct St6y_ .cI <br /> E PHONE <br /> PHO Site Plan approval from , <br /> ((j 08) atq _ c o TTTCCC applica•IP townhip. JI! <br /> E-MAIL E-MAILADDRESS <br /> ma{-� fLe E� S b c to b d. Yl c� 1:4 Floor plans to sca e <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑ NUMBER Q5 IG '-35,.-`)G IO- 4 �H 3 j (2 frontage drawn to seal- <br /> TOWNSHIP: SECTION:skt.A A-I 4.v1 c) w - . <br /> 3.J 1�4: N � 1�41�4: • It ` <br /> ADDRESS: (state,county,+o n <br /> 'AZ) I O (c� St4 Rct B 'GOk(tjv� tWr 535 �1 I� Sanitary •- .its <br /> CSM: Q ® LOT SUBDIVISION BLOCK/LOT (public, • .�, <br /> ' I <br /> ss <br /> PROPOSED PROJECT INFORMATIONr <br /> PROJECT DESCRIPTION: (` y <br /> • IS This project is a new building or structure. <br /> a '� Itt�l US$ <br /> ❑This project is an addition/alteration to an existing building or structure. , <br /> `i„', <br /> SANITARY SERVICE: PERMIT NUMBER: # � ew <br /> FISEWER SEPTICs <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) J �z1 U <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: O/ s, <br /> �G j TOTAL SQUARE FOOTAGE: + ' t�Cl �x ” yZ� <br /> 2ND FLOOR: 3RD FLOOR: ,,©/ e <br /> 6� view L 0"; .' s <br /> ESTIMATED CONSTRUCTION COST: $ J 00 O t,0 . ,, �3a c-e--,../. :- <br /> (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 ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes El No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑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? / es ❑No <br /> `-/' 201 ' G° • •PLICATION MUST BE SIGNED <br /> TTT Continue on Back) <br /> 545-112(4f08) <br />