Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION .'S' T' " ' <br /> . <br /> O ER NAME <br /> Cu- - - . .OVIDE <br /> W <br /> iv n r !. <br /> O NER DDRESS (Numberr,Street, ity,,State, \,,' J, plet bsi � ��t LOPiW T <br /> �(�qC 11`` > 1 n VV 637 I l Restriction;Ion;CSM <br /> HOME PHONE CELL PHONE / E- AIL ADDRESS ) !, Variance(# ) <br /> 19;-0/-0- ''��V &V AIL 5@ e.r) kr + ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CON CTOR NAME ,,�� II-- `, <br /> �� n.QJ O b OLbO Y J ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> N <br /> (city,State,Zip) I pc (City,State,Zip) Setbacks <br /> ID <br /> PHONE PHONE <br /> LI <br /> applicable Site Plan townshipapproval .from <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE ❑ Elevation of property <br /> ❑ PARCEL 01910- 1_4, 0`-_4'Re• ( I Q I frontage drawn to scale. <br /> NUMBER I �rtt.�" !�7 TJ <br /> TOWN P: SECTION: <br /> tftn n 05' '/.: 6V1 %1A: NE ❑ Driveway permits <br /> ADDR (state,county,town) <br /> tk e_ p I ❑ Sanitary permits <br /> l. <br /> CSM: LOT [/ SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> P CT DESCRIPTION: > �� � <br /> o am-- i-h Dns 0-C.-kW e n7o <br /> ; of 64 ► n 4 £ IP 1$ ,7 <br /> �v <br /> ❑This project is a new building or structure. �(�!r �Y �� <br /> 0-This project is an additior an existing building or structure. <br /> SANITARY SERVIC e �- �1' <br /> PERMIT NUMBER: �?��` , � <br /> SEWER ❑SEPTIC - ` <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> :—.`;'-7-� ,,iii 14 rs°A�. - <br /> AREA TO NEAREST SQUARE FOOT <br /> x <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) £ - V <br /> BAS M T 1ST FLOOR: : i� <br /> " & <br /> �' ,, TOTAL SQUARE FOOTAGE: ,+, ��� A� �4 �{�� $ tea,, <br /> 2ND FLOOR: 3RD FLOOR: <br /> ;.**4- fr4Vikaltifil-44 <br /> ESTIMATED CONSTRUCTION COST <br /> (Please round to nearest dollar) $c (7C7 C) , 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Flo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? l ''es ,❑,No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes IM,N , <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes LId'No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> • 6. Is a location survey required? (see reverse) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? dYes ❑No <br /> (2 ,00 APPLICATION MUST BE SIGNED <br /> fc'e (Continue on Back) ■ -► -► <br /> 545-112(4/08) <br />