Laserfiche WebLink
• -7DO5e - , -0,7S : i 7. S-+ SD = 1 `1 . <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY.OWNER INFORMATION`,a;; - .,,zz;;_ ;'.;0jd`,;c;?;5,- , ;: .,.t.._ tv '::- 'w' CUSTOMER TO PROVIDE <br /> OWNER N{�AME <br /> L . 1/ i,, '' 5 A.r Ar . Zoning Status;CUP; <br /> OWNER ADD' :S umber reef,City,State,Zip) <br /> ..+ <br /> .0' <br /> j� geed Restriction;CSM <br /> C�tVON &/ Tom, �r �j� <br /> �e� � � �� % J� � Variance(#HE E AI A DRESS / <br /> kg Site Plan drawn to scale <br /> AGENT INFORMATION '? CONTRACTOR INFORMATION...,`"-'''.' s -nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (city,State,Zip) (City,State,Zip) % Setbacks <br /> PHONE PHONE • r Sit;PI approval from <br /> p able township:• <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> IoIans to scale <br /> PROPERTY/LOCATION INFORMATION :;(http:llaccessdane.co.danewi.usn;; Elevation of property <br /> PARENT PARCEL NUMBER: Cu ENT ONING: ACREAGE: p P rty <br /> ❑ PARCEL ,id 6 o� L frontage drawn to scale. <br /> NUMBER 3�J�_�� K/ — l <br /> TOWNSH SEC ION• <br /> Z°ho 1/: 0. L,f 1/4'/.: N_E 51 D w ermits <br /> ADDRESS: (Sta Unty,town) <br /> CSM: ,� /(Pcgrieg '/� , :LOC Or -�Sanita rmits <br /> S J 1 (pu ,private) <br /> PROPOSED PROJECT:INFORMATION, <br /> PROJECT DESCRIPTION: �; i r '1,,,,,I,� �� � �' <br /> P • SLR' ��-- z � <br /> 4 is <br /> jJ This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. ; -__ <br /> SANITARY SERVICE: },iw:F : - <br /> PERMIT NUM �� r <br /> ❑SEWER PTIC ,� * � a ig a <br /> s # ',, ,, <br /> HEIGHT IN FEET 9 +s NUMBER OF STORIES: (Not including basement) '` d IC <br /> // :# s as lai- <br /> AREA TO NEAREST SQUARE FOOT: A � � �` <br /> C <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Sri ,t � w <br /> BASEMENT: 1ST FLOOR: e �q �*r - +� <br /> 1�r 4, TOTAL SQUARE FOOTAGE: ,� i'i.� l tat.. •Iv',. t <br /> 2ND FLOOR: 3RD FLOOR: I �r �-7 �� �_ `, A <br /> ESTIMATED CONSTRUCTION COST: oT�"�s i A� <br /> (Please round to nearest dollar) ♦ "� "� "� "♦ ! Q�� +3 - ®�� 9 e�r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? - Yes o ❑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? El Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El 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) ❑Yes D4No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ►;1 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —I► —► —► <br /> 545-112(4/08) <br />