Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ww <br /> ZONING PERMIT APPLICATION w .countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME —.-- <br /> O/7 // / "4( SRez oning Status; CUP; <br /> OWNER ADDRESS (Number,Street, y,State,Zipy, 7 Deed Restriction;CSM <br /> 4/7' 8 /1a�r L D�C fit/ I `S`3�a / Variance(# ) <br /> ((perOJ! 7 9 / i oel / 70-,1 7 E-MAIL /` I / L, <br /> � SDR �C- �x r�C//arf'/1-eT ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Lik‘tre Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE it an approval from <br /> pl ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I @Vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL (09O 7//0V02.19-->e-/-/-/ a- , f,3 frontage drawn to scale. <br /> NUMBER ! <br /> TOWNSHIP: 0 7 SECTION: DnveW ermlt3 <br /> lAi CO 7 �j-�'-6-Xe q IA: Ai WA: N (stet ,co ty,town) <br /> ADDRESS: r <br /> �`Y 4 7 �� Col, G-e-6-/Ple S 35-19-1 ❑ Sanitary •ermits <br /> CSM: _ LOT SUBDIVISION BLOCK/LOT <br /> t' il (pub iiiiillo <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> K„,,_, S Fg -4- !\)Q j FA l&tgriing District <br /> U This project is a new building or structure. <br /> rmitted Use? <br /> 'This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: `4 'aural Address l 1:i SEWER SEPTIC (n- - 1 ∎ng HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) R Wetiand/Floodplaini <br /> -I.V.P-4,1.1:MI- ' a It -nt ; <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porch= ) ❑ ErosionControl perm <br /> BASEMENT: 1ST FLOOR: <br /> ��� (,- 1---1 �,�.,Y c s' ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 1 filling/access) <br /> 2ND FLO?5 c t 3RD FLOOR: `- G �� <br /> ESTIMATED CONS RUCTION COST: and - - a ':=.. . <br /> (Please round to nearest dollar) '♦ ♦ --► ♦ ♦ ♦ ) C) Ca <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes -.lo ❑Don't know <br /> 2. Is there a wetland or ttoodplain on or near the property? ❑Yes --- 4o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Lives �lo <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) Lives No ❑Don't know <br /> 7. Is this to correct a violation? CI Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i -► <br /> 545-112(4x18) <br />