Laserfiche WebLink
I `) 3-# <br /> • <br /> ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION . _.:-0-:`.:',� r� � : -r.-: �r;; . CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> to a 0 IV — eve_ ' oning Status;CUP; <br /> o ER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> '1) kA_LeS"e,/ C.,7 Variance(# ) <br /> HOME PHONE C LPHONE E-MAIL ADDRESS <br /> -+ • A )itS A ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION ' and includes dimensions <br /> AGENT NAME ` ` ` CONTRACTOR NAME <br /> �,,e., • , 'L I 4 ! 0 N ❑ Site Plan including location <br /> AGENTADDRES CONTRACTOR ADDRESS of well/septic <br /> 5q 4 I L-es-e et-7 16 54q/4,iecc,�,/ C-7 . <br /> (City,State,Zip) (City,State,Zip) J ❑ Setbacks <br /> a._ _ 534 <br /> PHONE PHONE to Pla pproval from <br /> 6,017- 06-/I 5LI t� — ! /659 applic le wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION-INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> �g PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> 1 ' NUMBER Ogog Xkt{- 6p''q 1Z-1C—LI '7 frontage drawn to scale. <br /> TOWNSHIP: SECTION: Q <br /> • \L ' '/: 5�.. %1/4: P►E 0\DriV ermits <br /> AD.'ESS: - ` (stated \ty'town) <br /> CSM: 'J/ 4At.eS-y C-T 4#16 SUBDIVISION cala- ziki-e- ' 1 W Z 53 <br /> Sanit mits <br /> `� (publ• , ivate) <br /> au tC. •a►1, • <br /> PROPOSED PROJECT INFORMATION, cg TAr 4 <br /> PROJECT DESCRIPTION: �; a, � <br /> ;' � <br /> This project is a new .uilding or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. .. 4 <br /> SANITARY SERVICE: PERMIT NUMBER: ' p°t .a - ` <br /> SEWER r- SEPTIC i �MV .r. <br /> 't,,_: <br /> IN FEET: NUMBER OF STORNot including basement) : „ `..-� <br /> -. <br /> ' e 3By ' '. <br /> a i � <br /> AREA TO NEAREST SQUARE FOOT: 'z-� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) -"`' . <br /> BASEMENT: 1ST FLOOR: � m ® a a s F ' <br /> ∎- ��� � 4, TOTAL SQUARE FOOTAGE: • st �°, 5�. <br /> 2ND FLOOR: 3RD FLOO•: « <br /> .111wr—_ 1 , e 1 <br /> ESTIMATED CONSTRUCTION COST: r , t e ` <br /> (Please round to nearest dollar) "► -► -► �Q �� ) .„, 41 ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes .No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Y ❑No ❑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? es ❑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 e= • ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes i4 No <br /> APPLICATION MUST BE SIGNED <br /> 545.112(4/08) <br /> (Continue on Back) -i -► -♦ <br />