Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# , <br /> PROPERTY OWNER INFORMATION „,'.; z_ ', w 0 .x._.`t ,,,;:* <br /> 4; CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> 5.. <br /> A 5ov,f4 11/ UtA 01 Zoning Status;CUP; ih.--$„/OWNER ADDRESS (Number,Street,City,State,Zip) I eed Restriction;CS M <br /> SG'// Mg 1444/e gL, Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60 10 GSA 32 &t'9 J33'WZ3 Yd Site Plan drawn to scale <br /> AGENT INFORMATION.<_;:, CONTRACTOR INFORMATION '',,%;;-i and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> GLE///l Du/4/044 Ce),9' Site Plan including location <br /> AGENT ADDRESS CONTRACTOF>;ADDRESS \ of well/septic <br /> (City,State,Zip) (city,state,Zip f A Setbacks 63/7 00/6/_c-o <br /> VeA0 /A J41- -C3s13 ,y S'te Plan approval from <br /> PHONE PHONE ,� // <br /> 000 377 SS3® applicable township: ✓V <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> #r4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION :(http://accessdane.co.dane.wLus/) Elevation of <br /> property <br /> y PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ UM ER 03610.12 /I.2-9zZO $ 4-1 <br /> 6-)( 6. 4f frontage drawn to scale. <br /> TOWNSHIP: /� ^ SECTION: } � A,11/./Al �� Driveway permits /( <br /> t x11- /6 IA: 5 1/Y: �, /v <br /> ADDRESS: et All f/, (State,COUnty,�) <br /> cs 4Q/ D,/Z#/Vt// AEI SUBDIVISION 1 W BLOCK/LOT a 1 XSanitarype itss A <br /> - i .3 (publi <br /> PROPOSED PROJECT INFORMATION, , ; � <br /> PROJECT DESCRIPTION: is <br /> ' .r- t' • •L (• (.1 a i: 'a l ,iA Lz / 01_I v e `f 4-4 -� ,s `k 9 <br /> p <br /> This project is a new building or structure. 9-CC ,°� <br /> ❑This project is an addition/alteration to an existing building or structure. =' - • t <br /> SANITARY SERVICE: PERMIT NUMBER: i , ,ti,• �") °'ha '°,--❑SEWER 1:� SEPTIC I � �)t z e <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) • :� :4 <br /> /f a // / — <br /> AREA TO NEAREST SQUARE FOOT: 3 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) : �;: IJ <br /> g � 1 ��/ <br /> BASEMENT: 1ST FLOOR: <br /> � � s e5 e - <br /> TOTAL SQUARE FOOTAGE: _tAL, A.. 4 <br /> 2ND FLOOR: 3RD FLOOR: 4 ,�,. 4 <br /> ESTIMATED CONSTRUCTION COST: � -® n®ir. ,-,1":1-i4' <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ v1 fad O ,_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 141No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4No <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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> / 2 a APPLICATION MUST BE SIGNED <br /> (Continue on Back) -s -► -► <br /> 545-112(4108) <br />