Laserfiche WebLink
• ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N p�J <br /> Tt o.� ", , R t { 1 Zoning Status;CUP; i ) 4.-- <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ Deed Restriction;CSM <br /> 4g7 }4w4 KP LB\e.��Eac`- v-m- 535 ($ <br /> Variance j_# q ) <br /> HOME PHONE C LL PHONE E-MAIL ADDRESS " <br /> ,e:-767-3870 -=--_ - • - Site 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) Setbacks <br /> PHONE PHONE Site Plan approval from id 13-- <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: %Elevation of property <br /> LI PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> /: ,//: YDrivewa - its Kii4 <br /> ADDRESS: (state, ount town) <br /> K Pi k <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF Rev <br /> PROJECT DESCRIPTION: <br /> .64-6 fcr.3 e S 4,ed ..Zoning District �.-I A <br /> This project is a new building or structure. Permlttt Use �� <br /> U This project is an addition/alteration to an existing building or structure. � 4. �',, <br /> SANITARY SERVICE: PERMIT NUMBER: Rum A�. --. <br /> U SEWER U SEPTIC (n= <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) �( <br /> W r14 tl/ /L`'iJ <br /> SQUARE FOOT: <br /> wit*d (attachment) <br /> AREA TO NEAREST S <br /> Q <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ( Er0 e rM r A f f <br /> 4 TOTAL SQUARE FOOTAGE: 4 (.WO*disturbance, <br /> flllingla ,�) <br /> 2ND FLOOR: 3RD FLOOR: ,.., <br /> %. Rem Local nSdvey <br /> ESTIMATED CONSTRUCTION COST: Q� i■ —► —► e V d au�b options <br /> (Please round to nearest dollar) .p 'OW- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? U Yes yiNo U Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ' No U Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .Yes U No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ANo <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) U Yes 72tNo ❑Don't know <br /> 7. Is this to correct a violation? U Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -+ <br />