Laserfiche WebLink
. • . tl I 1 i <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT:to Web•App# <br /> PROPERTY OWNER iINFORMATION z; _:„_,', '.; ?'.-#.:-,i .,=,_. s, -+;; .,, CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 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 /> A 671. Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION ; , _,;-. and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �a ��_ <br /> ite Plan including loca n <br /> AGENT ADDRESS CONTRACTOR ADDRESS ' of well/septic /'Al . <br /> (City,State,Zip) (City,State,Zip) <br /> A }M Setbacks 1 <br /> PHONE PHONE • ❑ Sit Ian a a from <br /> appli wnship: <br /> E-MAIL ADDRESS E-MAIL ADDRESS .,( <br /> LI F oor plans to scale <br /> PROPERTY/LOCATION;INFORMATION .:(http:1/accessdane:co.dane.wi.asn: Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: eva P P rty <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER 0'3IZ- t21'°)tx")6 A- f eg go- 3 <br /> TOWNSHIP: SECTION: ❑ mitS <br /> A L-131 o•i k Z 1/4: 1/41/: <br /> ADDRESS: (St , oun town) <br /> ❑ its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (pU • ,prl e) <br /> PROPOSED PROJECT INFORMATION. <br /> F „r te �` <br /> PROJECT DESCRIPTION: <br /> -b'E'I�C -r" ,t, -��E Zi--i / <br /> )C .324 ':t76 n s r' TA rb xk <br /> P1This project is a new building or structure. ` , ` <br /> ❑This project is an addition/alteration to an existing building or structure. 4 r <br /> SANITARY SERVICE: PERMIT NUMBER: _ I -e arp"'i .' s- <br /> ❑SEWER SEPTIC NqA ; '� a -' � f. s <br /> HEIGHT IN FEET: j NUMBER OF STORIES: (Not including basement) 'z .. , ` <br /> IS AREA TO NEAREST SQUARE FOOT: : -- <br /> # % _ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � �= <br /> BASEMENT: 1ST FLOOR: �i e ,®j W 4 c <br /> ,�, TOTAL SQUARE FOOTAGE: 4, y t a d 3 ,eV <br /> €, �l - <br /> 2ND FLOOR: 3RD FLOOR: " <br /> ESTIMATED CONSTRUCTION COST: o g 3 <br /> (Please round to nearest dollar) --► "4. -4. -+ $ �� <br /> I(G r Cabo �a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes jJ No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ;"Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes iii 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 ❑No (Don't know <br /> 7. Is this to correct a violation? ❑Yes KNo L,Y(.-A •D iSov,w.`e7( - <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -4. <br /> 545-112(4/08) <br />