Laserfiche WebLink
-7( _ a—s-fS ( -=_--- - ---.)-ii <br /> ,SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY-OWNER i:1NFORMATION .,... z=_ ?,;' �,�„,01r .;:, r:.- t., ,": CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> F. Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C5SSite 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) .7.1 Setbacks <br /> PHONE PHONE Cr SItB proval from <br /> applic I.e t nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wims/) ❑ Elevation of ro e <br /> PARENT PARCEL NUMBER: CU ENT ZONING: AC GE P P rty <br /> ❑ PARCEL t<P1 ¶ <br /> _ , Ctj frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: Driveway p <br /> i .1/4.1/4:SECTION: - <br /> 4. <br /> °' (state,co ,town); <br /> 3 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) -- S 3 <br /> PROPOSED PROJECT INFORMATION, .o. <br /> PROJECT DESCRIPTION: 4 'r : -' ' <br /> S f R �k7. B N & t'' 4 <br /> ❑This project is a new building or structure. .�' W ° - <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: °9r - - <br /> '''''\q, {tD i S;❑SEWER ❑SEPTIC ' s <br /> i v 4-i. 'mss <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , � „ r- <br /> AREA TO NEAREST SQUARE FOOT: ��� <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) z 'BASEMENT 1ST FLOOR: 0 , „. €= � `�S <br /> I <br /> �• 4, TOTAL SQUARE FOOTAGE: j 44,,,..:4.7490 i t, ,?. - - A <br /> 2ND FLOOR: 3RD FLOOR: <br /> /3 3 E } <br /> yM��r° i<G�pr 6!`4 far: <br /> ESTIMATED CONSTRUCTION COST <br /> (Please round to nearest dollar) "� "� 'P ..4.,1-.. - 4.e.,-,z -.7- „” <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yelo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Ye�No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes +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 ❑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) -4. -4. -0. <br />