Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION .. CUSTOMER TO PROVIDE <br /> OWNERAME <br /> 0047 L L . PYeiMt7 <br /> ❑ Zoning Status P; <br /> OWNER ADDRES (Number,Street,City,State,Zip) D ed R ICtIOn;CSM <br /> 7 7 lj 3 �. e— lea. 7 3 v . Ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> q2o 62 3 /2S1 e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SELF 5 E t-c: Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE Site Plan approval from <br /> a..licable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> I F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danewi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONINGS.Sap ACREAGE: Elevation of property <br /> ❑ PARCEL 0)70/0` g C' 3 l G� q frontage drawn to scale. <br /> NUMBER /�%/� `����d �'d �� 'dJ f 5. 05 4,. <br /> TOWNSHIP: SECTION: <br /> 'Or K oq 1/4: St 1/1/: A/E ❑ Drivewa mits <br /> ADDRESS: (Sta ,county,town) <br /> 7753 Sib-_ kci 73 ❑ Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (p / c,private) <br /> PROPOSED PROJECT INFORMATION TA•PROJECT DESCRIPTION: p , 1 , J (_�(�•/y�'/ :_;., <br /> ❑This project is a new building or structure. $g - <br /> EIThis project is an addition/alteration to an existing building or structure. I 'F m z <br /> SANITARY SERVICE: PERMIT NUMBER: ; p e <br /> r 'il t <br /> :1-- 5-:"' ® `',❑SEWER SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ` '' <br /> AREA TO NEAREST SQUARE FOOT - ._. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' >„" <br /> BASEMENT: 1STFLOO f f' • 0 6g s <br /> 2- 6',, TOTAL SQUARE FOOTAGE: j • '� • Cc tti <br /> 2ND FLOOR: �� 3RD FLOOR: 7 a�� '° ` -'.4 <br /> ESTIMATED CONSTRUCTION COST: L' ' 1, <br /> (Please ) —► —► ..4.. --► —► trod �e.. • • a 5 <br /> Please round to nearest dollar 5, a � 3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes NI No LI 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'? NYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes tRiNo <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? ❑Yes �No <br /> l� � �� <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► —► -4. <br />