Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> O HiJ AA it)iirri44 A ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> - I tt 046 SToNi- RP. 0 Q66.vN w 1 �C--75 <br /> I Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ys /?ZS - / ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C <br /> 1.'r`-tF)(Zy ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /'j0 e1}oL"1 ST. <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> V tr.NA w 1 S 3C9 3 <br /> PHONE PHONE ❑ Site Plan approval from <br /> go z) 32 3 — 6-CSC) applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.vvi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> Li PAR fronts <br /> NUMCEL R Z frontage drawn to scale. <br /> b�1 o ZI N^°1�Sa 3 2 O g <br /> TOWNSHIP: SECTION: <br /> (Zu'tLPr,VD 2 '/a: S 'fa'/a: /� pp' CI Driveway permits <br /> ADDRESS: (state,county,town) <br /> `.fa(Y OL.) S ONE •D <br /> CI Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIE111f'" <br /> PROJECT DESCRIPTION: <br /> AP-Pr770/J -to XiST/NC, Part .ii'rfZjJ 0.ZoningDDist <br /> ❑This project is a new building or structure. Li Permitted, se? <br /> ®This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RturaiAddress <br /> ❑SEWER ❑SEPTIC (new/existin6)7 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ WettariliFS OlaFV <br /> S oretai tl attildhment)` <br /> AREA TO NEAREST SQUARE FOOT: ,„ <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: <br /> �..1 1E3e a att ai a a <br /> 0 4, TOTAL SQUARE FOOTAGE: 4, ( es e ' ° v <br /> f3tT, /at�SS <br /> 2ND FLOOR: 3RD FLOOR: 9 � � <br /> 60 ❑ <br /> . AG'1fIeW,49600 :niby: _ <br /> ESTIMATED CONSTRUCTION COST: $ S O 0 <br /> (Please round to nearest dollar) ♦ "� ♦ "♦ <br /> J . [lclv�iiabte crraS' <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 ln-No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2IYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -. <br />