Laserfiche WebLink
V 72_ <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> ow‘vp.NAm), 06, zeverr Zoning Status;CUP; <br /> OW ERA DRESS (Number, r City,State,Zi ) <br /> ,/°�jXy �q � #c to j -rga Deed Restriction;CSM <br /> �HJ.�" / <-�/ lo'°'� Variance(# ) <br /> HOME P ONE CELL PHONE E-MAIL ADDRESS ��,,// <br /> 041' -'It. 1"'�''R" 6tAfis-Q'' LJ"Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ,t c l i^i PO ite Plan including location <br /> AGENT ADDRESS CONTRACTOR of well/septic <br /> (City,State,Zip) (City,State,Zip) LT Setbacks <br /> ,MALL t!>_' <br /> PHONE PHONE 0 t:Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 13k kr; plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) vation of property <br /> PARENT PARCEL NUMBER: CURRENT2�"ING: ACREAGE: P P rty <br /> ❑ PARCEL 08 boo i 8 0 6°V /z / /SS. 7 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP. SECTION: <br /> gOtt . 14: /'C/t 141h: A/r ,I0' riveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> 1/3e Ivy/y toe ArPjj 1(1 S.35.3,) 11( anitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION s_' <br /> PROJECT DESCRIPTIO „ .,' k t , <br /> . ❑This project is a new building or structure. " 9 <br /> [„This project is an addition/alteration to an existing building or structure. „_re <br /> SANITARY SERVICE: PERMIT NUMBER: + c, ` °1- °,z i. ', <br /> ❑SEWER EPTIC a tilt <br /> x <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) le ,' ; ' <br /> AREA TO NEAREST SQUARE FOOT: — 0 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ` <br /> BASEMENT: 1ST FLOOR: + ® e - <br /> - �Q" 0 4, TOTAL SQUARE FOOTAGE: r �I ! t' +� <br /> 2ND FLOOR: 3RD FLOOR: U i � a <br /> a a - -,,,� enFy,,,,' � f-„ <br /> ESTIMATED CONSTRUCTION COST: �� e s 1' <br /> (Please round to nearest dollar) -i ♦ --► ♦ ♦ --► g d°v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Lld 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?..6.41A • ❑Yes 4 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 X No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes (kNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -1 <br /> 545-112(4/08) <br />