Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME . <br /> V e-I`c t G{n Pr Oa S 1.-k--(-- ❑ Zoning Status;CUP; <br /> OWNER ;DINS(i umber, ;City, te. � i Deed Restriction;CSM <br /> fttt�;JJJ� ` i li�L' :1/ S- •7 1_ Variance(# ) <br /> H(t fie' M-31ao QMl C ELL PHONE E•MAILADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 5' e /15 kft V e ❑ Site Plan Including location . <br /> 'AGENT ADDRESS CONTRACTOR ADDRESS Of well/septic <br /> (Ctty.Pate,Zip) (City,State.Zip) ❑ Setbacks <br /> PHONE • PHONE • ' ❑ Site Plan approval from <br /> . • applicable township: <br /> E-MAIL ADDRESS E•MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: t i-- ' ZONING: ACREAGE <br /> 0 P,ii u:CE1= 07O ,103 `40(04- o 4, I. C q 5 frontage drawn to scale. <br /> ; <br /> TOWNSHIP: ;ECTION: <br /> \ , ' '/'/: riveway permits <br /> lc A-01 e: (state,county,town) <br /> ADDRESS t • <br /> 0 03 4 • ■ a VSanitaz,penCSM: LOT 'el f ' sum ON BLOCK/LOT (publl private <br /> `� 1"Uc-�o 110. <br /> PROPOSED PROJECT INFORMATION ^^. <br /> PROJECT DESCRIPTION 5, re, _ i fido orlstrtkci-;, 1 <br /> • CD4his project is a new building or structure. <br /> 0 This project Is an additlonlaiteration to an existing building or structure. <br /> SANITARY SERVICE: __PERM M r�— -- -- <br /> ❑SEWER <br /> CI DJ L BEB( —-6 i DO03 / <br /> 1� HEIGHT IN FEET: 3 D i - NUMBER OF STORIES: (Not Including basement) <br /> )V AREA TO NEAREST SQUARE F007: <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT ii LI,ii AF4771 --) ,, TOTAL SQUARE FOOTAGE: j. <br /> 2ND FLOOR: 3RD FL oO <br /> n I(4, IDIA4. .re3/-1r) rr <br /> ESTIMATED CONSTRUCTION COST: ->► -► -. -, . -► i 6Ot p t <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 (.11tNo .0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? D Yes arNo 0 Don't know <br /> 3. Have you talked with the township about your project and are they In agreement? ,d es ❑No L1 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑No <br /> 5. Is this project associated-with a rezone/CUP/variance(petition/appeal# ) (I ve blank If none) <br /> 6. Is a location survey required? (see reverse) Yes ❑No 0 Don't know <br /> 7. Is this to correct a violation? ❑Yes °alio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Beck) -► -► -0• <br /> 548412(4104) <br />