Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> 1 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ) <br /> J� <br /> _dance(# <br /> 4 HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> V Site Plan drawn to scale ...j <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 12/Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,zip) Setbacks <br /> Eli <br /> PHONE PHONE to Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane. i.usn <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: Elevation of property <br /> ❑PNUMARCEL BER frontage drawn to scale. <br /> ) TOWNSHIP SECTION <br /> 1/4: '/4'/4: riveway permits <br /> ADDRESS: state, county,town) <br /> CSM. LOT SUBDIVISION BLOCK/LOT IA Sanitary p <br /> (public,privateermits) <br /> PROPOSED PROJECT INFORMATIONS <br /> PROJECT DESCRIPTION r <br /> 7— 3 Z 5 -e . , 'T, , DID. <br /> . ❑This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: r' <br /> ■.EWER ..EPTICt <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) <br /> Q1 x �-tl►"41'C/ <br /> d= . !f(FI , <br /> AREA TO NEAREST SQUARE FOOT: �_ F w_ - t�+ t / 4 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �, (�L��• <br /> a a" Oftr gt r, Con <br /> BASEMENT: 1ST FLOOR: �y�` <br /> 2678 1 TOTAL SQUARE FOOTAGE � ,di to <br /> 2ND FLOOR: 3RD FLOOR: <br /> +ti -'x� <br /> �� � 1 <br /> ESTIMATED CONSTRUCTION COST: , ! ...i T; <br /> (Please round to nearest dollar) $ . h <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es �lo ❑Don't kno N <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes I N. ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [V]Yes ►Tv �. <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? <br /> Eyes [ o <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) Eyes ENo ['Don't know <br /> 7. Is this to correct a violation? ❑yeso <br /> APPLICA MUST BE D <br /> 545-112(4/08) <br /> (Continue on TION Back) —► —►SIGNE-+ <br />