Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#- <br /> PROPERTY OWNER INFORMATION ;;.: __ .'.'a -` .r :="--c-=-- `.;4-11':=1:c_. CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1th 6 h lot 141VO rr''h ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number, be�et��City,State,Zip) 1` It() Deed Restriction;CSM <br /> HOME PHONE CE<'LL PHONE �� -MAIL M~L1� G��1 10 Variance(# ) <br /> 161 11el 1111 S : Vo art) c&i I 'V'0 4S• v.G+ s Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR;INFORMATION'' ,', ; and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> #S 41300 4.4 AL. I/ ❑ 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 <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION ':;(httpJ/accessdane.codane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> I=1 NMBER bo1 leS6-1-t 1-s S2.r <br /> R K-S t3 ,C rontage drawn to scale. <br /> TOWNSHIP: n SECTION: <br /> 17G+'r lq 1/4; 5 6- 1/1/,; 01,0 CI Driveway permits <br /> ADDRESS: ,1 (state,county,town) <br /> �3T?Z s»4.t,-- V"vM`E t& �e�td ‘)�. J��d ❑ Sanitary permits <br /> CSM: COT S BDIVISION BLOCK/LOT (public,private) <br /> O' . i c 2. �.C4 Z <br /> PROPOSED PROJECT INFORMATION. <br /> TA-c V �Y <br /> PROJECT DESCRIPTION: °te <br /> .This project is a new building or structure. 17.a <br /> ❑This project is an addition/alteration to an existing building or structure. m, �� . <br /> SANITARY SERVICE: N /L PERMIT NUM ER: ;%`�,°°14'x, `s'a <br /> ❑SEWER ❑SEPTIC T� 4 j .�� t - `- <br /> HEIGHT IN FEET: (I NUMBER O STORIES: (Not including basement) �' vv¢ �'y � <br /> AREA TO NEAREST SQUARE FOOT: 4 2�� Y' V <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` <br /> ei ,34 <br /> BASEMENT: 1ST FLOOR: <br /> hOkt..- O y a W <br /> 4, TOTAL SQUARE FOOTAGE: 4. I i� <br /> 2ND FLOOR: 3RD FLOOR: .o <br /> ► ► d < f€ 4 <br /> l ESTIMATED CONSTRUCTION COST ,s e i �(Please round to nearest dollar) '- . '- "+ '+ + $ 10 .V 0 Q . t .,_ -i � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LutVo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ANo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,.Yes LI No <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 I none) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -11. <br /> 545-112(4/08) <br />