Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> •PROPERTY OWNER INFORMATION' <br /> CUSTOMER TO PROVIDE <br /> Oi02I AnJ OISc , <br /> OWNER ADDRESS (Num�ber Street,C' ,State,Zip) ❑ Zoning Statu • UP; <br /> L/ 7 r 6 /J i4-4nt/t. y'J /� Deed R ction;CSM <br /> / �/ ri ce(# ) <br /> HOB E PHONE CELL PHONE E-MAIL ADDRESS <br /> 1 3 r 3 d q� °�c2 O 00 CO Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS o ell/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Site Plan a al from <br /> applica ownsh' <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ F or s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: j © CURRENT ZONI G: ACRE GE: Elevation of property <br /> ❑ PARCEL _ , ,N frontage drawn to scale. <br /> NUMBER a 7 I I�g�• - - <br /> TOWNSHIP: SECTION: _ <br /> C e C9 ro./p 0 a '/4: n.l %IA: /J r ❑ Drive permits <br /> ADDRESS: ;�� te,county,town) <br /> `1 7 1 (' 73.4 1 o`L '` ❑ Sanita •- mits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pu• ' ,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: /,...R ,�, <br /> f .� p <br /> This project is a new building or structure. s if*. 0 <br /> ❑This project is an additio alteration to an existing building or structure. : ' ' " <br /> SANITARY SERVICE: PERMIT NUMBER: , i° <br /> ❑SEWER SEPTIC `' F" ?J ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,x s ' <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) _; �` <br /> BASEMENT: 1ST FLOOR: rfr <br /> I 3 13 4, TOTAL SQUARE FOOTAGE: ,� t:-+ ' " ' ,rw <br /> /� - & e,tar"" . <br /> 2ND FLOOR: 3RD FLOOR: �� _ -� ' a g <br /> ESTIMATED CONSTRUCTION COST �_ , ,' <br /> (Please round to nearest dollar) •■ • ©� t � � � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes tLINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 No LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? VD Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L I No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if one) <br /> 6. Is a location survey required? (see reverse) ❑Yes o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 4No lq . 1 ( , rte. APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► —► <br />