Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY-OWNER,INFORMATION ', '4. �,,�, ,�, :=..,-=,-,-"-:-- ;";.41:-.z--z _ <br /> - w' CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 77k As 120T ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> (,7 9- S/6411/771_ D 21 v' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7311-01 3 ?3a--3 • C kors73 C aAoL. cog ❑ Site Plan drawn to scale <br /> AGENT INFORMATION:_:: , - ';; CONTRACTOR JNF.ORMATION:? -+ and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> t`-)/A ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> • <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:l/accessdane.co.dane.wLusn ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> PARCEL 0q I I'GI ai 1 ]i6 A-( , g9 frontage drawn to scale. <br /> NUMBER V`I ` � "'( rT 1 <br /> TOWNSHIP: , SECTION: <br /> / ❑ Driveway permits <br /> Q2l Sit L Z? 1/<: 5�-✓ 1/.1/: Gr (state,county,town) <br /> ADDRESS: , <br /> (071 g . SM1 U I L b el SUNPI24-t 0e t-+L. 535-90 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> WS-WA yes . .s <br /> PROPOSED PROJECT INFORMATIONPera <br /> PROJECT DESCRIPTION: r i " <br /> is VA's N , I x l6 c� S' « ! ��i iio <br /> This project is a new building or structure. ,' Ott <br /> This project is an addition/alteration to an existing building or structure. r. � <br /> SANITARY SERVICE: PERMIT NUMBER: 2�`t 1 ' o°4 � .'�:. <br /> if❑SEWER IPSEPTIC w 4:314i6:4°.:k1'- <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) - 43 _ , i <br /> AREA TO NEAREST SQUARE FOOT: , , <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) e ` s- _ g 0 ` <br /> BASEMENT 1ST FLOOR: a de <br /> 4, TOTAL SQUARE FOOTAGE: 4, -a�s - , :. €-.. <br /> 2ND FLOOR: 3RD FLOOR: 3 t <br /> /I/4SQ.-(r. <br /> ESTIMATED CONSTRUCTION COST: QQ�� g(Please round to nearest dollar) `P D00 D� ,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ( 'lllo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lo ❑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? pYes ❑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 I i to ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes FiNo <br /> 5-© <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) , <br /> (Continue on Back) -0. -► <br />