Laserfiche WebLink
f <br /> ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web.App# <br /> w <br /> PROPERTY.OWNER`.:INFORMATION j_.; ,__ %W,`c,0,ye.:•;;i ._.: r i r_`-k. CUSTOMER TO PROVIDE <br /> OWNER AME <br /> LAN ❑ Zoning Status;CUP; <br /> OWNER ADDRES ( St et,City, p) g ' ' <br /> 7 Deed Restriction;CSM <br /> HOME PHONE ! CELL OS E-MAIL ADDRESS <br /> h " / \ Variance(# ) <br /> /c/3- 7 3, ❑ Site Plan drawn to scale <br /> AGENT INFORMATION , ,i, - ,' CONTRACTOR INFORMATION'== and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> i ' Aid, • 1 _ e _A i . ❑ Site Plan including location <br /> AGENT•10. S Ce RACTOR ADDRESS of well/septic <br /> l �/Kff7Se C7/1" <br /> (City State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> 2; s7 �/9t <br /> 9 Oo56 S — applicable township: <br /> E •IL ADDRESS E-MAIL ADDRESS <br /> �� Pi �,. ❑ Floor plans to scale <br /> PROPERRTY/LOCATION:I;lFORMATION +.:(http:l/accessdane.co:dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ONING: ACREAGE: P P rtY <br /> ❑ NUMBER 0-5z C??Or-j 3 7/-"4N I it-,3(9 ,�'3 frontage drawn to scale. <br /> TOWNSHIP: SE TION <br /> : 1j .344 ./: 4 ,/,/4: A,'k) ❑ Driveway permits <br /> ADDRESS: —E�"� (state,county,town) <br /> csM:/7/(9 ar r SUBDIVISION BLOCK/LOT Sanitary permits <br /> i - L --7. `5� (public,private) <br /> PROPOSED PROJECT INFORMATION - , ; TA ., �t <br /> ' <br /> • PROJECT DESCRIPTION: �'� �a ,.� <br /> +._ k a L t <br /> ❑This project is - new building or structure. . , ` <br /> I% This project is an addition/alteration to an existing building or structure. ,. L, ,. <br /> SANITARY SERVICE: ma ' <br /> PERMIT NUMBER: 1 ear <br /> EWER SEPTIC c L, <br /> HEIGHT IN FEET t NUMBER OF STORIES: (Not including basement) . ' , W e ., <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 � <br /> BASEMENT: 1ST FLOOR: � : <br /> / !� 4, TOTAL SQUARE FOOTAGE: 4, z ; s.J J- t I?�n� <br /> 2ND FLOOR: 3RD FLOOR: GJ 1 <br /> /.s-0 3-o 7 76-y47-4;,.:,„- ...' <br /> ESTIMATED CONSTRUCTION COST: ti � -ko i , <br /> (Please round to nearest dollar) --► "•∎ "'∎ $ f Si& g'0 :. VV V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I' 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 gNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes MP 7 <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) CYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1:)4 No <br /> ; v <br /> • z_ APPLICATION MUST BE SIGNED <br /> � <br /> ' JV (Continue on Back) —► —► —0.545.112(4/08) ( 1 Z <br />