Laserfiche WebLink
A. &.2 <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ! <br /> --S-L 5'a fri /9Arcbi -fro ."' -c5/ <br /> ,,,soh L ' ingStatus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Restriction;CSM� ci d/fctjejz°,- LT h -1ti inc/5,e/aif s1 Afr,<3Ssg Variance ) <br /> HOME PRONE CELL PHONE E-MAIL ADDRESS <br /> 3 SW-Sia 3 6 l7'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME �� e . CONT TOR NAME <br /> >ev 6�tn /C .t, A- --e s t- '''CO Ar 5-7{,'4.-<-f oN A Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS r of well/septic <br /> / <br /> (City,State,Zip) (City,State,Zip) Zbacks <br /> (9" c7o�, we 5-35-25 Otc5°'�' w '' Sys^ 5� <br /> PHONE PHONE l_MJIiB Plan approval from <br /> r!t a r— F3 s - 3‘/6 'D 3- '3.3----34/ 4 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS ,f <br /> L7 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1e'' '7 el 1/a: /,�/,; 1D 'veway permits <br /> ADDRESS: (state,county,town) <br /> a-y be i i A,c tc 4t-- C R.0 inc f Ahott, taz s ass 6 <br /> CSM: LOT SUBDIVISION BLOCK/LOT t 'nitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION F717 4. � L,1 <br /> PROD CT DESCRIPTION: t� <br /> 4,t.-' <br /> / t f -x <br /> ❑,/This project is a new buildi g or structure. �� �� 3 <br /> LrThis project is an addition Iteratior)to an existing building or structure. <br /> SANITARY SERV E: PERMIT NUMBER: -' �' ' ',w;',' <br /> SEWER ❑SEPTIC ' ° a,- ,'i", <br /> HEI HT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> /VAL /A.".% 1 -- !,r/afirii ii''''''-'t4I'd :;;1,-:::',1‘ '.,' --`', <br /> " ; <br /> AREA TO • AREST SQUARE FOOT: �= � -, �� �-��� ;' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 3 .- 9 � . 5-"g r <br /> BASEMENT: 1ST FLOOR: + h` <br /> /S�. 04.7 + TOTAL SQUARE FOOTAGE: j 4. �-- • ;34- 4 <br /> 2ND FLOOR: 3 D FLOOR: ' <br /> ESTIMATED CONSTRUCTION ST: ♦ ♦ ♦ -► --► ♦ �— 0 -� a�n w - , <br /> (Please round to nearest dollar) J ©� , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes ,,U o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Li No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EKes ❑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 blan)none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ETNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2iTlo <br /> APIA US B- <br /> (Continue PL C on TION BacMk)T ►E SIGNED—► <br /> 545-112(4/08) <br />