Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to Web..App# <br /> PROPERTY OWNER INFORMATION „:; . 1 :'; .4 N ..,-. . < c, -+ , CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Greg u/er ❑ Zoning Status;CUP; <br /> OWNER/ARE SS (Number,Street,gity,State,Zip) / Deed Restriction;CSM <br /> 6011 A/ea i l�' ' �-r�.3-�c;2. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • <br /> 32-? — ❑ Site Plan drawn to scale <br /> AGENT INFORMATION ,,: : CONTRACTOR INFORMATION ;:`: „ - and includes dimensions <br /> AG Nr5ME // CONTRACTOR NAME <br /> /L od eag XgRejhae/„ 7 LLB ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS V of well/septic <br /> 3"359 "A✓ / <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> GtJecu..�,Q1�ee S.3S7 2 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (j cO? OP9— ?9S applicable township: <br /> E-MAIL ADDRESS E-MM *SDRESS <br /> e 1/ i — - p, ❑ Floor plans to scale <br /> PROPERTY/LOCATION;I INFORMATION +.;(http://accessdane.co.dane.wi.usn ❑ Elevation of property <br /> PARENT PARCEL N MBER: CURRENT ZONIN9,:. ACREAGE: P P rtY <br /> ❑ PARCEL - �1 0 ^� y,�_ / frontage drawn to scale. <br /> NUMBER bJb�c7C�4'� �QZ[{�O �f ^1��x �st D�ib <br /> TOWNSHIP: '� �� SECTION: ❑ Driveway,2O . : A)Gt/ 1/4'/.: Ste/ ypermits <br /> ADDRESfri,ltr <br /> / l l ,� (state,county,town) <br /> 7(9Oy f/es 71 )I/e 7 GAL S. S�v2_ ❑ Sanity <br /> ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION, <br /> PROJECT D SCRIPTION: �' <br /> q. 1 .c z'- w <br /> / /� iotrs S -9 X59 '�, --- q -,,s �, <br /> ❑This project is a new building or structure. � q 4r <br /> This project is an addition/alteration to an existing building or structure. j ,- ,} `- .'g2-4, '" <br /> SANITARY SERVICE: • PERMIT NUMBER: i Ai � ; <br /> l�I p sF <br /> SEWER 0 SEPTIC : "0 <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) - <br /> 16 riF �� <br /> K AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) a' tiY � <br /> BASEMENT: 1ST FLOOR: 7 ®� ° , r°�I <br /> J�� i7-00 ,�, TOTAL SQUARE FOOTAGE: r t`V) E <br /> 2ND FLOOR: 3RD FLOOR: ; . ,. ” <br /> ESTIMATED CONSTRUCTION COST: g <br /> (Please round to nearest dollar) "'∎ '� -+ --∎ $ re rx � , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Jg'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes .WNo <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 o� a Don't know <br /> 7. Is this to correct a violation? ❑Yes 4:11 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. —► —► <br /> 545-112(4/08) <br />