Laserfiche WebLink
16 tcp-i- coifert , <br /> 7-1712-k <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,, n <br /> Col Vy,k�.0� rra `.2 `. ❑ Zoning Status;CUP; <br /> OWNE DDRESS (Number,Street.City,State,Zip) C� Deed Restriction;CSM <br /> - 5-6,,,‘1,frnvot ! Variance(# &leo ) <br /> HOME PHONE CEL PHONNE/, E-MAIL ADDRESS/ <br /> O <br /> 603 7 _ 3F`iSca l<Q - mi\ ' I ctsr1 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S tt P ( c 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 'etbacks <br /> PHONE PHONE i.∎ rte 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.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ NUMBER 0(D (0 '-234 -q3/1 5 le-5 , 20 outage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> D L iv n) (Ls 1,4, 5E %At.. M) Driveway permits <br /> ADDRESS: c (state,county,town) <br /> CSM: LOT .BD ION BLOCK/LOT II ani permits <br /> I . D� (public,private) <br /> PROPOSED PROJECT INFORMATION QIb <br /> PROJECT DESCRIPTION '"--, -; <br /> -�,�•� �1� r / � <br /> A �, ` <br /> . ❑This project is a new building or structure. ,.. ; '-'..:.. 11—,q2r � �: ". � <br /> laThis project is an addition/alteration to an existing building or structure. r ` <br /> SANITARY SERVICE: PERMIT NU ^ °�'��, � - '" <br /> ta SEWER ❑SEPTIC �� a ' 'r 7 ,,-�. <br /> . BH` i'a&�" '3 's: <br /> HEIGHT IN FEET: �+�/ NUMBER OF STORIES: (Not including basement) , d <br /> / . .G/'� - 4120 C•ay4.r.',4,5 St. <br /> AREA TO NEAREST SQUARE FOOT: ',� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porch:-) -:` , t ' <br /> BASEMENT: 1ST FLOOR: e ' <br /> OO© 4, TOTAL SQUARE FOOTAGE: ,A . a d t"X83? f <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST ° " i ' t "j <br /> -► -► ♦ -0. -► -► <br /> (Please round to nearest dollar) 30 �O C7� \:....5Z1----- , ;, <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? NYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - l Yes ❑No•_ _ _- -_- -. ,ith a rezone/CUP/variance •etition/a..eal r leave blank' no - . <br /> 6. Is a location survey required? (see reverse) Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? •Yes ikt No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► <br />