Laserfiche WebLink
S° 0 . 0'? S---eS- ---- /in it <br /> .ZONING PERMIT APPLICATION www.countyofdane.com `;SUPPLEMENT=to Welb-App#,. <br /> PROPERTY.:OWNER INFORMATION?a.,;;* =x'. ` 3 , -4`41,: J tilt <br /> OWNER NAME <br /> �_ CUSTOMER TO PROVIDE <br /> Tt,h., , D-eKq Cc ii/./-z <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 0_Zoning Status;CUP; <br /> 3 7S-? n?�PlIP,-- j a Fv'PS1 i_� Deed Restriction;CSM <br /> �' 3 S 3 Z <br /> HOME PHONE CELL PHONE Variance(# <br /> E-MAIL ADDRESS ) <br /> 6v8 rfif-7?s/ 606-ys--s-- 7/3c -C4.0-,-P- 0 $1 P✓"t'04'.-- C'o--- <br /> N AGENT.INFORMATION `;. Site Plan drawn to scale <br /> AGENT NAME CONTRACTOR;JNFORMATION and includes dimensions <br /> CONTRACTOR NAME <br /> AGENT ADDRESS r'_ Site Plan including location <br /> CONTRACTOR AD -E of well/septic <br /> • <br /> (City,State,Zip) (City,State,Zip) <br /> -- Setbacks <br /> PHONE PHONE PIN Site Plan approval from <br /> E-MAIL ADDRESS applicable township: <br /> E-MAIL ADDRESS <br /> IZ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION;.;(httpe//accessdane.co danewi us ���/// <br /> LI PARENT PARCEL NUMBER: CUR ENT ZONING: ACREAGE: n Elevation of property <br /> PARCEL <br /> NUMBER QC!/o 13 1 -�)/o-p H-/•e A 1 0 rontage drawn to scale. <br /> TOWNSHIP: SECTION: / _ <br /> L'J !/ S�r 1 S I : iv - %IABU E R Driveway petmits <br /> ADORE (state,oty,town) <br /> 7S / Iv\,,( 11t c <br /> CSM: LOT <br /> 6/� SUBDIVISION BLOCK/LOT Sanita private) <br /> (pub rivate) <br /> PROPOSED PROJECT INFORMATION <br /> ` , ' �I <br /> h <br /> fir PROJECT DESCRIPTION: e ,�. i- .02oi y0 r n s <br /> This project is a new building or structure. x a , <br /> ❑This project is an addition/alteration to an existing building or structure. - <br /> ,;fir ` ` w'' <br /> SANITARY SERVICE: '''� I.,x <br /> ❑SEWER ►i' EPTIC --- <br /> HEIGHT IN FEET NUMBER 0 S DRIES: (Not including basement) yy %T z s = <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) _ <br /> BASEMENT: <br /> 1ST FLOOR: R e e i s e o` <br /> a <br /> 5 OQ 4, TOTAL SQUARE FOOTAGE: 4, e�s e, T <br /> 2ND FLOOR: <br /> � t`k <br /> 3RD FLOOR: i.,' , <br /> ESTIMATED CONSTRUCTION COST _ <br /> (Please round to nearest dollar —► "► —► -* --► (3'—e, ° e I ` � <br /> O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes Iii No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> ❑Yes ;RiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes , 4No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes kell 5. Is this project associated with a rezone/CUP/variance(petition/appeal# No <br /> (p PP ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) CI Yes ❑No <br /> 7. Is this to correct a violation? <br /> know <br /> ❑Yes F%I No <br /> APPLICATION MUST BE SIGNED <br /> sas»z(4/08) (Continue on Back) —o. —► —+ <br />