Laserfiche WebLink
Wet z60b . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT fo Web•App# <br /> PROPERTY OWNER INFORMATION i; _ W u r,��,-ATM : .�. M1ri _R <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Ccll�e,Q_\I, Nas [ <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑ Zoning Status;CUP; <br /> u 3 `� �� 0. h ti�V\ 1 o yt ' � �� Deed Restriction;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> bag c3c (7. .C.,), 6OZ- a3S 9s9 a Co 1k AA∎ Hos 1,-,k),(- C Yh 3i Y15- c�"I'Y [j Site Plan drawn to scale <br /> AGENT INFORMATION - CONTRACTOR;INFORMATION <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR NAME <br /> C91 'C2ti asUz-- 1 1 <br /> AGENT ADDRESS -'& =_�� -1 - ❑ Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> SCR Cw t 4 a Oa vh ca a.atnn Oth-c e, r <br /> (City,State,Zip) ( ity State,Zip) _ ❑ Setbacks <br /> ` <br /> PHONE ' 6,,Akb-wv\ ) CD �L J 3-7 I I <br /> PHONE ❑ Site Plan approval from <br /> -6oZ - 1 — 7/ z S applicable township. <br /> P <br /> E-MAIL ADDRESS <br /> h / � ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION (http://accessdane.co danew1 us n <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ PARCEL <br /> NUMBER 0 25/a Col o- 3A4-9?1)0-'1 R VI a j , o frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> �-/\i/1 -1,-\ 3 a 1/,: 1/%: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION, <br /> PROJECT DESCRIPTION: L�� �� .4„ € <br /> o ' x a ' - L• <br /> CI This project is a new building or structure. _: ; <br /> DI This project is an addition/alteration to an existing building or structure. r _s.,r 1 <br /> SANITARY SERVICE: �T <br /> PERMIT NUMBER: e f, �t <br /> SEWER 0 SEPTIC _________ <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) L- ' ' <br /> • <br /> � ® ryi 4; (®ffia <br /> AREA TO NEAREST SQUARE FOOT: �L�� t <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ` 6 €-4 <br /> BASEMENT 1ST FLOOR: (R pp-� <br /> ` s a a� i ”O , U 4, TOTAL SQUARE FOOTAGE: � � � c . <br /> iA ' `2ND FLOOR: 3RD FLOOR: , <br /> ESTIMATED CONSTRUCTION COST: ` a itf cit;' <br /> (Please round to nearest dollar) ". '+ '� -► -► j ��. = o qtr, <br /> R <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes . 1 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> CI Yes gilNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? AN Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1No <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 IN <br /> No CI Don't know <br /> 7. Is this to correct a violation? ❑Yes R No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 l4/0e6 (Continue on Back) -► -* -♦ <br />