Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWA1GIiiblAME <br /> 4 1 h^ irs C- ❑ Zoning Status;CUP; <br /> OWNS ADDRESS ( umber,Street,Ci State Zip) {� � <br /> 39%5- Mg11p„J<y (A , 4✓ a nS 3'3ccg Deed Restriction;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> 6°?'F3P 40 1) 66,8* 2.101-91-t I Pull 4f . ' t Mc t_ Cdr." ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRAC R NAME , 1 <br /> I r 1 (r$ ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) Sa mC_ a c a 6uV e_ - <br /> ( ty, a (City,State,Zip) ❑ 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.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ NUMBER ► as/O 610-161-$030-I Ai - `..X 3 .8 frontage drawn to scale. <br /> TOWNSHIP:ff SECTI : c ❑ Driveway V h!^t /b 1/4: lV E %1/4: N y permits <br /> ADDRESS: (state,county,town) <br /> 3q g7$- 141GAcogy fJ 1 c�f a0 (i1 Y 3s-sq <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION :: <br /> PROJECT DESCRIPTION: {� ��'• y <br /> • Zil This project is a new building or structure. `- i � +a <br /> ❑This project is an addition/alteration to an existing building or structure. , . r- �, <br /> SANITARY SERVICE: PERMIT NUMBER: iLTF e a 3 <br /> ❑SEWER ❑SEPTIC -' a a ' ,- <br /> HEIG IN FEET: / (� ` / NUMBER OF STORIES: (Not including basement) ,- -1 �' <br /> 5 I tJcu!) ' ).2 r e cif. - I ' 'f £a 5:0,1z E i <br /> AREA TO NEAREST SQUARE FOOT: 4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) `£ <br /> BASEMENT: 1ST FLOOR: <br /> ()() 4, TOTAL SQUARE FOOTAGE: ,, ° �' " - 1 <br /> 2ND FLOOR: 3RD FLOOR: i 1 <br /> ESTIMATED CONSTRUCTION COST: ii : . :' . <br /> (Please round to nearest dollar) ♦ --► ♦ ♦ ♦ --► $ /Q e <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 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? Si Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0 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) DYes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes N No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -3 <br /> 545-112(4/08) <br />