|
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME I �j(J�'��f.��i-
<br /> JO - Oct"'�t " Zily 5-4 Zip)
<br /> oning Status; CUP;
<br /> J O R ADDRESS umber, ree, ate,Zi
<br /> 5! /P ,f S Deed Variance Restriction; CSM
<br /> Variance(# )
<br /> HO E PHONE CELL P ONe E-MAIL ADDRESS
<br /> 'f.'4 ,Rite flan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> j(I 4 $(,/�Q 11,( j a Plan including location
<br /> A TADD SS CONTRACT DDRESS � of well/septic
<br /> (City, ate,Zip) A (City,State,Zip) - •
<br /> PHONE PHONE ` + t /i ❑Site Plan approval from i'e,ot 410 - applicable township.
<br /> E-MAIL ADDRESS E-MAIL AD,RESS
<br /> �/j `„ ; , I, i�� ' oar plans to scale
<br /> PROPERTY/LOCATION INFORMATION (httr,://accessdane.co.dane.wi.us/) atio Of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE n ef
<br /> 2 p P y
<br /> El PARCEL N UMBER 06 O 1 QS q4 00C). . A - / 2 !� frontage drawn to scale.
<br /> TOWNSHIP: SECTION:
<br /> P[2,10(0,12,4, S '/<: NJ 0 'h. : ❑Drive a ermits
<br /> ADDRESS: (stet , ounty,town)
<br /> CSI3 titl 1 Lgoibt2
<br /> SUBDIVISION BLOCK/LOT anitary •-••••ts A40
<br /> (public •riv- -
<br /> n
<br /> PROPOSED PROJECT INFORMATION i
<br /> PROJECT DESCRIPTION:
<br /> WA64t 12 Diet
<br /> . 12 This project is a new building or structure. 1:7 a e?
<br /> This project is an addition/alteration to an existing building or structure.
<br /> :-tii- ::;,;.: :.,:),.,.,-.D,,,,,,,,, ..,:._ ,,,, ,:,: :
<br /> SANITARY SERVICE: PERMIT NUMBER:
<br /> EWER /0EPTIC "�"'
<br /> HEIGHT IN FEE//' / ' NUMBER OF STORIES: (Not including basement)
<br /> ter aaF a s x s a
<br /> REA TO NEAREST SQUARE FOOT:
<br /> dimensions including unfinished area,attached garages and above grade decks or porches) :,'":40;;;;- ....p.,,1,7D,C,"g
<br /> BASEMENT: 1ST FLOOR: i � �t,
<br /> O/ . + TOTAL SQUARE FOOTAGE: j ( ,-
<br /> L//-I d;5-; a a�%•
<br /> 2ND FLOOR: 3RD FLOOR: la/t"
<br /> ESTIMATED CONSTRUCTION COST: " "' tom: "
<br /> (Please round to nearest dollar) -+ $ 39/a90 ,
<br /> 1. The roe is within 300 feet of a stream or 1000 feet from a and or lake? JYes N f
<br /> property rty� pond � �o Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? QYes Ali. o ['Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? QYes ao
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? JYes 1410
<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) JYes lty4 o ['Don't know
<br /> 7. Is this to correct a violation? [JYes jaio
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) • —► —►
<br /> 545-112(4ro8)
<br />
|