Laserfiche WebLink
• <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME • <br /> V 2 `4t d I 1-1-oviti I L.&...( �,g status;CUP; <br /> WNER DO (Number eL Ci , Deed Restriction;CSM <br /> (} ) I ' ' ,- U 0 . ,t tt:ii .5' 1 i variance(#_______) <br /> H CELL PHONE E.MALADDRESS <br /> "7l S• drawn to scale , • <br /> AGENT INFORMATION f CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME �,h • CONTRACTOR NAME <br /> 5 r 'E tO v P ❑Site Plan including location <br /> AGENT •••z.S CONTRACTOR ADDRESS of well/septic <br /> • <br /> cuy,eare,zip) icsy,stale.ZIP) 0 Setbacks <br /> NONE PHONE <br /> –*\ /__ <br /> 0 Site Plan approval from <br /> .>\''' <br /> appflcabie township. <br /> E-MAIL ADDRESS E•MAS.ADDRESS <br /> D Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:1,accessdane.ca.dane.wi.usI) Bevationofproperty <br /> D PARENT PARCEL NUMBER CURRENT ACREAGE: frontage drawn to scale. <br /> Cr/C) 03 Hallo A - I .-76� <br /> TCflNNSHP SECnONt i t D.Driveway permits <br /> ApDRE lC7Ga 1171 ^_ �• /i. (state,county,town) <br /> \/CSM: ' O Sanitary permits <br /> V CSM: LOT , SUBDIVISION 4'13—LOCK/LOT (public,private) ' <br /> j u_I-4oIto <br /> PROPOSED PROJECT INFORMATION <br /> . PROJECT DESCRIPTION: .5 d LoA. elt�.l 1 <br /> . ®v'his project is a new building or structure. • <br /> D This project is an addition/aiteration to an existing building or structure. <br /> _.P�BMtT�RI --" ..-" <br /> -- E1MER D SEPTIC' /1 r O`D / —0 0 0 2 <br /> HEIGHT IN FEET. 2 V�� NUMBER OF STORIES:. Inducting basement) <br /> q <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outside dimensions Including unfinished area,attached garages and above grade decks or porches) <br /> •BASEMENT: 1ST FLOOR _: TOW.SQUARE FOOTAGE: ; <br /> l3 1' ;L 4/3"9140-4-. <br /> ,2ND FLOOR: 3r0 FLOOR: �l )1 / �TIJ � <br /> / 9 S „ i <br /> ESTIMATED CONSTRUCTION COSY -► -0. -+ - -� l� r (>1 - 00 <br /> (Please round to nearest dollar) ww <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? D.Yes tNo •0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? D Yes t No 0 Don't know <br /> 3..Have you talked with the township about your project and are they in agreement? *es 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes D No <br /> 5. Is this project assoclated•with a rezone/CUP/variance(petition/appeal# ) ( blank If none) <br /> 6. Is a location survey required? (see reverse) lbYes D No 0 Don't know <br /> 7. Is this to correct a violation? DYes M"No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -I• -4. <br /> 545412(4100) <br />