Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#: <br /> PROPERTY.OWNER INFORMATION, s.;; _ __:_:. ' ,;„aTM,.�-, ,._; t J , <br /> OWNSq NAME CUSTOMER TO PROVIDE <br /> -Iiz7-E.-A/ y ❑ Zoning Status; <br /> OWNER ADDRESS (Number,Street City,State,Zip) g tUS;CUP; <br /> /092 !ND /2/oiC� / Deed Restriction;CSM <br /> s/ Variance(# ) <br /> HOME HONE CELL PHONE E-MAIL ADDRES <br /> 2 ^� 'bb ! Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION r „< and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /0 leity ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTORADDRESS J of well/septic <br /> (City,State,Zip) / 3 4 z �v . <br /> (c 7/,/ & �/ 5357? CI Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> z-Z5 6zi8 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADpRESS <br /> -.I 44 �)7 G A/qr- ❑ Floor plans to scale <br /> PROPERTY/LOCATION'INFORMATION'::(http://accessdane.co.danewi.usTh <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL 5'/,/ -7 359 4 / frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: ...-92,75--5 SECTION: �/l <br /> Q/Sil,. .PA Lc 6 6-7 l/. 5 / 1/4%: � . ❑ Driveway permits <br /> AD Ess:�1 (state,county,town) <br /> /g93 �'4�'p /D ��/-7 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> 224' , Z <br /> PROPOSED PROJECT INFORMATION, ' I--; . <br /> PROJECT DESCRIPTION: - fir V f <br /> ❑This project is a new building or structure. ,tx <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: g cl , 4 <br /> ❑SEWER �6ERTIC � d �� k . <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) $ y <br /> AREA TO NEAREST SQUARE FOOT: i <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t: <br /> BASEMENT: 1ST FLOOR: e e U1" a � <br /> A° 1 4, TOTAL SQUARE FOOTAGE: 4 � .,.. t ,, <br /> 2ND FLOOR: 3RD FLOOR: =- :.'', <br /> 1 a 'l'£33�rC 9°F `4, y0 �£ <br /> ESTIMATED CONSTRUCTION COST: ♦ —0. ♦ ♦ ♦ -- �' ® }p V <br /> (Please round to nearest dollar) 'P /2 V Y ,, : <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes )LNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Eako ❑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 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) DYes ❑No Ei Don't know <br /> 7. Is this to correct a violation? ❑Yes O.No <br /> 38 <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —■ --1. <br />