|
SUPPLEMENT to Web•App#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> V ‘c. \-1 A R`h u 1, A 1,A) ❑ Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,S ate,Zip) Deed Restriction;CSM
<br /> g. BeAc L/ WOIe- Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> L48 Y.3735 $/.S ?70 2 c]%? 7'g c4-,Ft rN ) (ii, it p( , C G ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> n ❑ Site Plan including location
<br /> AGENT ADDRESS CAS CONTRACTOR ADDRESS S of well/septic
<br /> .e A
<br /> (City,stag NCL- (City,State,zip ❑ Setbacks
<br /> PHONE PHONE 0 ❑ 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 /> LI PARCEL O5)Z 3 I 0 106-a �3 d b R 3 frontage drawn to scale.
<br /> NUM
<br /> TOWNSHIP: SECTION:
<br /> iemu, u of= V1L% i o t.+ 3(0 1/4: I\jp 1/.1/4; )3E. ❑ Driveway permits
<br /> ADDRESS: (state,county,town)
<br /> X3 ACLS4 Rue Ebcegro w t 3 534
<br /> ❑ Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> g i G H c...,(50 1)) (public,private)
<br /> PROPOSED PROJECT INFORMATION -3
<br /> PROJECT DESCRIPTION: ' s `
<br /> v` �0 .
<br /> ' ' - rOQo_ N?u I r 49 r"Te, r(odb — p,AcseAc.iL'n/x3c, 0 7.6 4 Ace -,LL .-t �'
<br /> . ❑This project is a new building or structure. t �:
<br /> i i, - ,,
<br /> g This project is an addition/alteration to an existing building or structure. x
<br /> SANITARY SERVICE: �� ��®° ,� -, :-
<br /> SEWER ❑SEPTIC � B' T
<br /> ,r
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -f.� -, '
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,' 3 ,4
<br /> BASEMENT: 1STFLOOR: ; � ..,,,,,,,,,,,,'A.,,,-,• P
<br /> ,� TOTAL SQUARE FOOTAGE: 4, ••* •i 'xt-? ice � ,;,
<br /> /2 G � • e zee i ,dx
<br /> 2ND FLOOR: 3RD FLOOR: , r a;- - '
<br /> d / 360 so F ,fig
<br /> C) it'd t>
<br /> ESTIMATED CONSTRUCTION COST:
<br /> --► -1► —► ♦ -♦ --P, •• • a• • r-
<br /> (Please round to nearest dollar) SOO
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? El Yes ❑No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes ❑No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 0Yes LI 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) Wes ❑No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes ®No
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -4. -► —►
<br /> 545-112(4/08)
<br />
|