Laserfiche WebLink
!ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O R NAME ,/� <br /> "D( Cc. I'// /u�o ❑ Zoning Status;CUP; <br /> ID ER DRESS (Numbber Street City,State,Zip), /// �p Q , D Deed Restriction;CSM <br /> 0. 1Z1 /`i"6, /ems 9✓ � Variance # <br /> i�� ( ) <br /> HOME P •NE ENE -MAIL ADDRESS <br /> 1 �:1��' /1/1/P-- /-t. G d e�.: Site Plan drawn to scale <br /> AGENT INFORMATION CON RACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Xr Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ll Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) \ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PMBEEL R 0 9'I ;01 e?0 I V�� 1,3---- <br /> J^' fronts a drawn to scale. <br /> TOWNSHIP: SECTION: <br /> %7�� ,A. ,/,/4: ❑ Driveway permits <br /> '�/ (state,county,town) <br /> ADDRESS: /' <br /> el-ff2Z,P49 <br /> V ta/4 -- fixii-(A--,-- (,, a)1 53---C ° ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION M <br /> PROJECT DESCRIPTION: , . ' <br /> -.'_ •� _ _ J 070 x�_ f Y � " <br /> rr// 5 3 sx ru ` KK� <br /> . This project is a new building or structure. TADfi <br /> ❑This project is an addition/alteration to an existing building or structure. -, r <br /> SANITARY SERVICE: PERMIT NUMBER: '�� i'i ,-" <br /> ❑SEWER e3S'EPTIC 431 a ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ; F ' �� <br /> I A/L_ Int. u�i. sir L , _ ` <br /> AREA TO NEAREST SQUARE FOO 4 1 _, <br /> �� �. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �«#4 - "�"` <br /> BASEMENT: 1ST FLOOR: :� p <br /> 4, TOTAL SQUARE FOOTAGE: , �.1 *�� t� <br /> 2ND FLOOR: 6 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: oo x r a aY* � 1 <br /> (Please round to nearest dollar) "� � � 60 � � _ : 1,' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes t=1 No ❑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? Li Yes '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 ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes Q'No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ —► —► <br />