Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / Fe-Cy-Too-4 L)A 2Y El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM OL �...-..4. 6 4, oC L� � `,/i. S3 53-Q` <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> • 5—: ' ' —L/tV' ,.-2 9 • . 5 G:L,,-Q s . ©Site Plan drawn to scale <br /> AGENT INFORMATION I 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 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.us/) ❑'Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> IN NUPARCEL MBER 05(Z.-tc.,3'9sjo-o -‘ 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Al—ISt�r�t .5r 1,4: . \j Y :$EA.r 16 El Driveway permits <br /> ADDRESS: // A - (state,county,town) <br /> «o �OIaKTY Zo A , r,bf2-roa Ur 5 55 Ianitary permits <br /> CSM: LOT SUBDIVISION fi4. K/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF <br /> PROJECT DESCRIPTION: ,, - E a t_� <br /> Lt.' <br /> A oc�-tcoa �� ��P1aT� 1` 1AS _�L J�►'re_ IbOR mr 3'[St11Ct <br /> ❑This project is a new building or structure. , <br /> �; ttf4{ Ise <br /> 21This project is an addition/alteration to an existing buildlhg`or structur <br /> SANITARY SERVICE: PERMIT NUMBEF c' / . '"�1D r . <br /> EWER MEPTIC � � � ' <br /> r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including bas�Ihe ' a <br /> �f � <br /> O ( ant) <br /> AREA TO NEAREST SQUARE FOOT: f > <br /> (Outside dimensions including unfinished area,attached ga'r`ages and above grade decks or,`porches) ,. <br /> BASEMENT: 1ST FLOOR: T c ,, xPt� <br /> zSx 3Z OG?� Z4o,L3'i E3,84: TOTAL SQUARE FOOTAGE: it trace, <br /> 2ND FLOOR: beR:f'd' P ut L oc..%el— LAPotee r -: ro <br /> 74 % 06/1 Z8$Z. e 9 6 62A A f�� � i ( 'iivt. ton urvey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please dollar) � � � � � � $ 4D,000 <br /> Please round to nearest dollar � ;�'� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes I2lo EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes laic, <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 o ❑Don't know <br /> 7. Is this to correct a violation? [Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />