Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNS NAME <br /> \I ,gPS gar-e //fere 1 ' T je Zoning Status;CUP; <br /> OWNER ADDRESS (number,Street,City,S ,Zip) Deed Restriction;CSM <br /> ? 5- ,j pct i°" Variance(# ) <br /> HOME PHONE NE CELL PH E -MAIL ADDRESS <br /> 1, ,fj - , j- ' ✓a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> _ ► Site Plan including location <br /> 7 - ,1Ire V �.' _ <br /> •GENT A DRESS CONTRACTOR ADDRESS of well/septic <br /> 65o5 de- c c '136 St---u- t , e(- 53 <br /> ( State,Zip) (City,State,Zip) 1. Setbacks• <br /> PHONE PHONE - • Site Plan approval from <br /> ,F55- 2--- OQ s b applicable township. <br /> E-∎AIL ADDRESS E-MAIL ADDRESS <br /> ` ii. ` , � loor plans to scale <br /> PROPERTY/LLICATION INFORMATION (http://accessdane.co.dane.wLus/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p, levation of property <br /> ❑ PARCEL 6?p 0 '`/`2-5633 -0 frontage drawn to scale. <br /> NUM <br /> TOWNSHIP: SECTION: <br /> Oh cI 1,7 r '/4: -1/41/4: /O3 Drivewa ermits <br /> ADDRESS: (state ounty,town) <br /> 4.0c- A P. L i �� ►■ Sanit permits <br /> CSM: OT S :DIVISION BLOCK/LOT (p IC,private) <br /> 411%..._L ! _ua_ <br /> PROPOSED PROJECT INFORMATION ( ' <br /> PROJECT DESCRIPTION: <br /> mei tJ , if) /�(,�f/n/ lam/rG iC a t <br /> . ❑This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. 4 t' <br /> SANITARY SERVICE: PERMIT NUMBER: °•® '" <br /> ❑SEWER ❑SEPTIC "; .Q " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -1 r '- '" <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) g s r_:t1 �V o t <br /> BASEMENT: 1ST FL OR:� � <br /> 4, TOTAL SQUARE FOOTAGE: ,, . .. v W °BC1 i <br /> 2ND FLOOR: 3RD FLOOR: _- l ; <br /> ESTIMATED CONSTRUCTION COST: ,,tl ` '0 <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ S� O 8�t-- .i,,,9.,4,!1-1.4.7-:;,,,,-,,,,,,, <br /> ... <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'No on't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑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 Li No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />