Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER`1NFORMATION< :. .y ` ' :mow 0,, .. `*:''<_` _.` CUSTOMER TO PROVIDE <br /> OWNER NAME \--‘. ` <br /> ��O//Nos J O(1 S wOY� l.-- kA\ ❑ Zoning Stat ,, P; <br /> OWNER ADDRESS (Number Street,City,State,Zip) Q�/'`�, S (0) P�1c Deed striction;CSM <br /> HOME PHONE E\\DC∎1 - E AI DRESS � U01 JJ Jr�� ance(# ) <br /> ( DS `7 .3-s si i a,.o"?'g i S ,no - @ .4 S: Si Plan drawn to scale <br /> AGENT INFORMATION.;. CONTRACTOR INFORMATION; , , `: d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (AiNf\.`e Si e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Site Plan oval from <br /> appli a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> lour plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) El ation of property <br /> PARENT PARCEL UMBER: ( CURRENT ZONING: ACREAGE: ` P P y <br /> ❑ NUMBER 00(1 Ogoi -.S_g ,c*j-O LC 1 d / . S( fr nt e drawn to scale. <br /> TOWNSHIP SEC 12 Oy: c <br /> c�, ..1� �C, _ ,: /- % : n) Ki Dr' away permits <br /> AD t ( ate,county,town) <br /> ` .`� 1 sal 1 '(\ d. b r •�01 A.) S Sa 'ary permits <br /> CSM: /C) �� LOT SUBDIVISION ) BLOCK/LOT (p,.tic,private) <br /> PROPOSED PROJECT INFORMATION <br /> c�v 4 7 477'.r7;:-:"E., E �t 4' <br /> PROJ' T DESCRIPTION: �� ( � f <br /> 0 This project is a new building or structure. <br /> m <br /> ❑This project is an addition/ Iteration to an existing building or structure. _' <br /> , r „ <br /> SANITARY SERVICE: PERMIT NUMBER: A �°,,,..ow.-- _ � E <br /> ❑SEWER EPTIC t .. s a�� F '�,. <br /> R :r <br /> HEIGHT IN FEET: NUMBER OF STQRIES: (Not including basement) ? ��' a5 '' 1::°1--';.1's o h w- <br /> 0 t <br /> AREA TO NEAREST SQUARE FOOT: { g4- 3,4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' <br /> BASEMENT: 1ST FLOOR: /� O e ® n ® ' <br /> Uj TOTAL SQUARE FOOTAGE: ,, a. 1 <br /> 2ND FLOOR: 3RD FLOOR: <br /> ° G c`7 <br /> ESTIMATED CONSTRUCTION COST: s e �.,I . r`p d. , - <br /> —► -► -. -► -i -� <br /> (Please round to nearest dollar) ) ©� _ -. , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 11 es VI Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lips 'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank' ne) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> C v ? 2 LI In APPLICATION MUST BE SIGNED <br /> `� (Continue on Back) —► —► <br /> 545-112(4/0B) <br />