Laserfiche WebLink
ZONING PERMIT APPLICATION www,countyofdane.com SUPPLEMENT.10AWeb App># <br /> PROPERTY`OWNER°INFORMATION r,%-X::.F� •,�._ �- '- ::` ._ -a.) �5,. _ �, +':-: CUSTOMER TO PROVIDE <br /> OWNER NAME / �- <br /> 12/ES L -R4 Ck Qw/ (�Cie7:eil"//vW//� (/- t :.t(1 n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 7 /90 .�� 4 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE p CELL PHONE E-MAIL ADDRESS <br /> 4./I37 70�a 6 6�0020 i 7 0 ..7-xL65h-6 .4- wmt4-/e-- El Site Plan drawn to scale <br /> 4.'AGENTtIINFORMATIOItI, ,u ` &A fCONTRACTOtiRINFOR ItiT10N a{ and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plan including location <br /> AGENTADDRESS CONTRACTOR ADDRESS • of well/septic <br /> (City,State,Zip) (City,State,Zip) - ❑Setbacks <br /> PHONE PHONE n Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS - • <br /> ❑ Floor plans to scale <br /> 'PROPERTY/L OCATION INFORMAT IOR._:(http.Uacces5idane.co,dane:vin.us%)' ,, n Elevation of property <br /> PARENT PARCEL NUMBER: . CURRENT ZONING: ACREAGE: <br /> L- PARCEL ea ,/y,/ 973/- C_ Z S frontage drawn to scale. <br /> NUMBER 7 7 <br /> TOWNSW: - SECTIO • <br /> /e/ -7-O L (,4 / ,/4. IR .. El Driveway permits <br /> ADDRESS: ( � 7 (state, County,town) <br /> 7( 0 C�0 49- To/v6? -/e/ N 5-35-W <br /> n Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public private) <br /> PROPOSED PROJECT-INFORMATION , ': "� Tr` RVi ,Y; <br /> =� .� _' � a <br /> PROJECT DESCRIPTION: _-+.-°w - ,-- <br /> [Thisproject is a new building or structure. a- <br /> P 1 9 Is;ed; °s <br /> ❑This project is an addition/alteration to an existing building or structure. -, �' _ <br /> SANITARY SERVICE: PERMIT NUMBER: ,� .. ,1-. ef,-,:- ,..&..!----..„-- -..... <br /> . r)EWER . [EPT1C :4`-'7".;:-..M.,.?'644916_ �,4i� . ' <br /> -� '' '� € <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) A 3 � <br /> . 72 o r e ` -pm ivje I! . ° ,k, <br /> AREA TO NEAREST SQUARE FOOT � , 4- «4 ;-- ' - <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) '- }� --- ' <br /> o A s, r• a errs <br /> BASEMENT; • : 1ST FLOOR: J/ n ti <br /> . /f 6Q 0 ' ;j, TOTAL SQUARE FOOTAGE 4, _ 6 x'' 6 '_ <br /> • 77 v <br /> 2ND FLOOR: 3RD FLOOR: �w '' a <br /> • c�e00 t <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ Q ' � � h4 e 6 P ', <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-' EINo.- fDon't-know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Elo .❑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 DI • - . <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) Dyes Jlo - ❑Don't know <br /> 7. Is this to correct a violation? - ❑Yes ao . <br /> APPLICATION MUST BE SIGNED <br /> • - - (Continue on Back) -* -t► --I. ' <br /> 545-112{4ro9) ' <br />