Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION - CUSTOMER TO PROVIDE <br /> OWN NAME <br /> L)q c <br /> V % /" 'Qv c t kr n 5 ego 10' ❑ Zoning Status;CUP; <br /> OWNER ADD SS (NumS;reeCCi ,State,j�p] Y �� I <br /> 5-6'7 C lyy��,`j T/� Deed Restriction;CSM <br /> 4 S1 s4_1 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 3 4— g ? 2' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 4 C NN RAC RMAE /� <br /> , 01101 / k, 11'- /Ca. � V get...) (_o ,. -41 C ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR AD ESS of well/septic <br /> i9,23.2. -r-44.0^ all-Y12- 91' ?—" St . <br /> (City,State, ipl , �. / 1 (City,State Zip) `T �� ❑ Setbacks <br /> /� d1 (t 2 c151 ;. fr1 c P.�,.. 14„, «!! S 3 S3- <br /> PHONE PHONE 0 ❑ Site Plan approval from <br /> D 2 -- et I.t—3 37 ? La ? — 738 -6 7 4'7 applicable township: <br /> E-MAILADDRES II E-MAIL ADDRESS <br /> J TM 1 r st d f• A --/ ❑ 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 /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Sb,-,-"5 ;c ,/: ,/,/4; ❑ Driveway permits <br /> / <br /> (state,county,town <br /> ADDRESS '7 C N 'n / ( y' ) <br /> S D K ~G �\! ❑ Sanitary permits <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT D S IPT N: °e� $ <br /> . .1n1 This project is a new building or structure. X ,,, <br /> ❑This project is an addition/alteration to an existing building or structure. 4-° T <br /> SANITARY SERVICE: PERMIT NUMBER: " �,4','° ' z,- ' <br /> ❑SEWER .. JEPTIC -1;,_,; <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 4'-;'s s , <br /> Y ,6 f: € S� 6 <br /> AREA TO NEAREST SQUARE FOOT: t 4 �fi� F <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) _ r-�,j <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: �,, at `., " !,, , <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: �`T B f ® " r-i. <br /> (Please round to nearest dollar) ♦ ♦ -► -► --0 "0. $r/ sSg A., , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑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 ❑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 ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -0 -0 -0 <br />