Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER;:INFORMATION„,;::, _ _, 3 - .0 ;` ;i:r," g CUSTOMER TO PROVIDE <br /> OWNER NAME ,, (fin <br /> 5 Lt- owt ❑ Zoning Status;CUP; <br /> OWN R ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> it) I IU O E�1q'��6 0 I - it�6 _ 760 5353 Variance(# ) <br /> H•MEPHONE CELL PH NE -� E-MAIL ADDRESS <br /> 4 <br /> f 2.5 . .2.26. .2.26 q2 <br /> • i 0 5k Lt_a , , _ —A-,_„a 4 Site Plan drawn to scale <br /> AGENT INFORMATION :; CONTRACTOR INFORMATION :;• and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ 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-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION'INFORMATION (http://accessdane.co.dane.wi.usi) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER A02/6$/4344b731-Z 11)-I cX/12-3 0 7U7___ frontage drawn to scale. <br /> TOWNSHIP: SECTION: ❑ Driveway permits <br /> ADDRESS: -- ` (state,county,town) <br /> "7 L L f-W)1V AJ g,�4�d 012— COG G1`( 6 N 536 3"( W( ❑ Sanitary permits <br /> CSM: LOT 1 I SUBDIVISION BLOCtuLOT (public,private) <br /> PROPOSED PROJECT INFORMATION. ' mot' TA -� <br /> PROJECT D CRIPTION: •'1'''''.. ., a <br /> ❑This project is a new building or structure. ��-4-5 2,1 <br /> OThis project is an addition/alteration to an existing building or structure. _p , �' <br /> SANITARY SERVICE: PERMIT NUMBER: & I� gala t e <br /> SEWER ❑SEPTIC FT;IFL,,,714A.,t,,,.. �a,0 ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -== '} ',. <br /> AREA TO NEAREST SQUARE FOOT: 1� � <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �, - <br /> BASEMENT: 1ST FLOOR: ®� ® r <br /> -z h ,, TOTAL SQUARE FOOTAGE: 4 e- ,1_ ,: <br /> 2ND FLOOR: 3RD FLOOR: 0- � ���� <br /> ESTIMATED CONSTRUCTION COST: 2 ' <br /> (Please round to nearest dollar) '♦ ♦ '♦ --► --► ♦ $ J p 0.00R 0 ®dC�; <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? L -Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 81Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? it/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 n't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> CO-°° <br /> APPLICATION MUST BE SIGNED <br /> � ( D (Continue on Back) --I.--I. —► —► <br /> 545112(4/08) <br />