Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 60a-r reAl 4-- R'ccHt 0/3 or) ❑ Zoning Stapes,CUP; <br /> OWNER ADDRESS (Number,Street,City,Stat ,Zip) <br /> Deed J9estnction;CSM <br /> 5700 0)/b Kerl Rdl Cras3I°(C4 isi� I s35ae Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Ali ;- ID • -7i2._'B lv kc,o) s a'@ +d 5• vie. ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan ap a from <br /> applic ownship: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I�t� <br /> PARENT PARCEL NUMBER: CURRENT ZONI : ACREAGE: G Elevation of property <br /> ❑ PARCEL 4-�L'I 77 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> B e rrn ,/: ,/4,/: ❑ Driveway its <br /> ADDRESS: (state ounty,town) <br /> 6-7 i- 6-f1'o Merl C�—�SS P t z-s,S, u)L 53 5a-3 ❑ Sanitary its <br /> CSM: LOT 1 SUBDIVISION BLOCK/LOT <br /> /0 S /Y (publ' ,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ^s --'"4171-7, � z <br /> bl <br /> %This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. �- <br /> SANITARY SERVICE: NA PERMIT NUMBER: t <br /> ❑SEWER ❑SEPTIC ,!r:;•' 1,-;: a x m '- � �c" <br /> HEIGHT IN FEET: y NUMBER OF/S�TORIES: (Not including basement) <br /> 1 03 � <1 (40 ID <br /> AREA TO NEAREST SQUARE FOOT: $ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) €�� . <br /> BASEMENT: 1ST FLOOR: 7 <br /> ® ® ® r o <br /> NA Jt1 x 4 u 4, TOTAL SQU E FOOTAGE 4 t4, i g .,s: <br /> P$ _ <br /> 2ND FLOOR: NA- 3RD FLOOR: , <br /> ESTIMATED CONSTRUCTION COST: 0(, $'� <br /> —► —► --► -� —► ♦ i �. a e . i,, <br /> (Please round to nearest dollar) $ (j� � a '� k Z , <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? ❑YesIo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? IgYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ONo <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) CI Yes Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —I• —► <br /> ( ) <br />