Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Twirls /L4F� ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3 gS J/ /t' 14 8 fticFiRIltrif/o !.f/l S XS-5-8. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> `r ; r, 7 - ('19073 N9 , « ' Vt '/2A-) war tE Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and 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) L� Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn 11 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: L►�'clevation of property <br /> PARCEL _ J_ frontage drawn to scale. <br /> NUMBER q <br /> TOWNSHIP: exa(o_ 0_14. 4c15lU..( SECTION: <br /> PM/E/1 5.14/5€ %: /9 1/41/4: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> 27r5 mvs 8 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> &' 04/64P/Marl (public,private) <br /> PROPOSED PROJECT INFORMATION ° '" <br /> PROJECT DESCRIPTION: - -,d=; <br /> ,4p1DfTlow to G6�k,' J< � ,� e <br /> • ❑pis project is a new building or structure. , <br /> Ly1 This project is an addition/alteration to an existing building or structure. , -' - <br /> SANITARY SERVIC PERMIT NUMBER: 7 f' "P. t °° , °;,,;. <br /> L]SEWER ❑SEPTIC ,- ,° ' - <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) _"' -, <br /> /240 / A ues W.,V <br /> AREA TO NEAREST SQUARE FOOT: .- � ,, '� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) y _ � �? <br /> BASEMENT: 1ST FLOOR: -,®� ° ° <br /> `J3 TOTAL SQUARE FOOTAGE: jr ° , <br /> 2ND FLOOR: 3RD FLOOR: <br /> & °4 <br /> ESTIMATED CONSTRUCTION COST: ° _`°$a° <br /> ♦ -► -� -► -0. -0 <br /> (Please round to nearest dollar) 70,o:00 <br /> � - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? s ,ERIo ❑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? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes io <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? CI Yes 's-No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -* - <br /> 545.112(4/08) <br />