Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION` CUSTOMER TO PROVIDE <br /> OWNER �E� <br /> cLo `t "' IBC 1Qe/t( Ky QQ <br /> , Zoning Status;CUP;O, , <br /> OWNER ADDRESS (Num.=r,Street City, e,Zip) Deed Restriction;CSM <br /> -'72--( I •• Ao S Variance(# ) <br /> HOME PHONE C LL PHONE E-MAIL ADDRESS <br /> 120 Ito >gS' it'd Site Plan drawn to scale / // /O '1 <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0% . -n1..10 g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ' well/septic /� /s/co <br /> (City,State,Zip) (City,State,Zip) 'Setbacks 'j3 �% �i <br /> PHONE PHONE OM Site Plan approval from / <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> `►. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) ` <br /> PARENT PARCEL NUMBER: CURREN Of�JNG: ACRE E: �//rte, Elevation of property <br /> ❑ PARCEL OM -1 3Z9 Z2o6 M / I �� , frontage drawn to scale. <br /> NUMBER ` <br /> TOWNSHIP: (n1 SECTIO h � �" � <br /> e. - / 1/: 1 1/4: /V Vv �!L Driveway permit <br /> , 4-- <br /> ADDRESS: // / tate, :rmit1),,f 0 . h 4 INS CSM: LOT SUBDIVISION BLOCK/LOT � Ss <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �q�� h! 441- _` ^ rk "� i. , } z OP <br /> ❑This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. _ �� t <br /> SANITARY SERVICE: PERMIT NUMBER: " -Ceolgt = ," <br /> ❑SEWER DoSEPTIC f M '' *Q2'` '" <br /> HEIGHT IN FEET: / :^ NUMBER OF STORIES: (Not inc ding basement) . <br /> / <br /> C,.' <br /> s_�r'' �'$a-;,--0,3 s i':...7', <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) : £� ,,„ .4 4 <br /> BASEMENT: 1ST FLOOR:_ ® $ �� <br /> eZ + TOTAL SQUARE FOOTAGE: 1 ��.d A1� ad as� - ,, <br /> 2ND FLOOR: 3RD FLOOR: ' � ' a / <br /> alP S/2 ,-x mac. . <br /> s��a <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ }� ' i $, <br /> (Please round to nearest dollar) $ /500.0 - X42 , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes F,St No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ;it No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? LYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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 5a No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/09) <br /> (Continue on Back) ■ —► —► <br />