Laserfiche WebLink
0.. ( _—tg —qc?--(5- <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ��jj <br /> MIT e I L P MA Nc E51ti I ❑ Zoning Status;CUP; <br /> OWNER ADDRESS i(Nu�ber,S rest, 0;$t Z p)sON s <br /> 3 //�L''//�1 I/\-/ Tf�t• Il mil"`. 04404,,,wI, Deed Restriction;CSM <br /> Variance(# ) <br /> OM PHO ��� , CELL PHONE N/Pt E-MAIL ADDRESS C�A <br /> ' N J Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL Oh 12,1931315_S frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: ,�" SECTION: <br /> hn�� �1-s 1/<: 1/1/: (.3 Driveway permits <br /> ADDRESS: 1 (�14W \wl C01bRk1E �/� (state,county,town) <br /> 2 t&7 ` ' Yv • ` I. 53.S2- 3 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION 4 <br /> PROJECT DESCRIPTION: .p .': . s ' <br /> • ❑This project is a new building or structure. x 01, ; , a <br /> This project is an addition/alteration to an existing building or structure. <br /> ,e> <br /> SANITARY SERVICE: PERMIT NUMBER: �� <br /> e a � <br /> ❑SEWER XEPTIC :4 s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �`� ^�, if' � o� <br /> ' A-?!-=:-" <br /> AREA TO NEAREST SQUARE FOOT: V� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r,,�$ e `` k <br /> BASEMENT: 1ST FLOOR: :d . <br /> ID � 2Z1 , 4, TOTAL SQUARE FOOTAGE: 4, .iF, .,m1��� <br /> 2ND FLOOR: 3RD FLOOR: { <br /> 225 r." �� <br /> ESTIMATED CONSTRUCTION COST: Z . , s, 4 <br /> (Please round to nearest dollar) ♦ ♦ ♦ "♦ "♦ c OO. <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? %Yes ,❑�o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes y.YNo <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 LI No ,krDon't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> Z (Continue on Back) ■ -► -11. <br /> 545-112(4/08) <br />