Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM <br /> /��{�/pEy��,,L{/�V(/_/�� �' �g Set-)2 <br /> Zoning Status;CUP; <br /> OWNS ADORE (Numbe, tree City,Sta <br /> 2 Zip) f Deed Restriction;CSM <br /> 000 yy /< e,1,/ /' /-/,tr=p.6' c: s-7 2- Variance(# ) <br /> HOME PHONE CtL PHONE E-MAIL ADDRESS <br /> CO — • ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME f_ / CONTRACTOR NAME <br /> A/!1 .S/ IS/56t(�,/PCl rijr (( ' s-)44.k LI Site Plan including location <br /> /GENTA RESS CONTRACTOR ADDRESS of well/septic <br /> 6 3 0 S 1411 rrs" r/v • <br /> (City,State,Zip) (City,State,Zip) LI Setbacks <br /> Lori(; b): S s c S <br /> PHONE PHONE ❑ Site Plan approval from <br /> Z,; ) S 2 ci o s---.b applicable township. <br /> E- •IL ADDRESS E-MAIL ADDRESS <br /> ( .4r c ' c . ems , cc <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL <br /> PAR CELNUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> Li UBER 06 7'o/f Q 5 z-^ A-1 <br /> —7, �- frontage drawn to scale. <br /> TOWNSHIP: SECT <br /> SViz, dab)f p %: 1/.1/: ❑ Driveway permits <br /> ADDRESS: 1 (state,county,town) <br /> g000 ((( / '` P 0Y-, ' S 3 S 72 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: +, � <br /> - /D 0 - 1 1 Vic <br /> .' . <br /> . ❑This project is a new building or structure. tt� k <br /> This project is an addition/alteration to an existing building or structure. � <br /> SANITARY SERVICE: p ERMIT. SE ? r e a �1z:= <br /> ❑SEWER Al SEPTIC . a i s A . k ; x <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) n <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �' °' <br /> BASEMENT: 1ST FLOOR: 91 a ; A— <br /> ,, TOTAL SQUARE FOOTAGE: 4, i: �i �'� <br /> 's" '7'71150 rAtrfSte 2ND FLOOR: 314O FLOOR: ', <br /> 7 EEC i -.✓ .^.' <br /> ESTIMATED CONSTRUCTION COST: Q� .' <br /> (Please round to nearest dollar) "0 "� $ �r (J �� t AA <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ces ❑No ❑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? 01 es ❑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 LI Don't know <br /> 7. Is this to correct a violation? ❑Yes )No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) <br />