Laserfiche WebLink
, <br /> ZONING PERMIT APPLICATION ww.countyofdane.con1 SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION'.: <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> JUSki►'') VOuPRQ` ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> y-162 G1 SEnl ow-e--9 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS �,/ <br /> ` z N--°�9 l!1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME ,,��' <br /> CO scot $u,LO 5 LL C_ Ly"Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) a Setbacks <br /> OS2—e. �o Lr- S3 S <br /> PHONE PHONE ❑ Site Plan approval from <br /> $3 S -oil-gg applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ,.,__,/� <br /> LI�'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑ PARCEL O42/o�9 „l3‘}-fil8&2 SZ_ l frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑ Driveway!3 1/4: SE 1/41/4: SE ypermits <br /> ADDRESS: (state,county,town) <br /> '-1- 62. FE'S 4.v'- 2 s•k (39-eaoJ, , l 53575 <br /> LI Sanitary LOT SUBDIVISION BLOCK/LOT ry permits <br /> cA)-k.`Y HuS1i.5 (public,private) <br /> PROPOSED PROJECT INFORMATION °` ' <br /> PROJECT D SC IPTION: 'e�� . � . <br /> A i ' J o HoM`Q. u 8 , l' <br /> ❑This project is a new building or structure. r - ` w <br /> This project is an addition/alteration to an existing building or structure. � - - -� <br /> SANITARY SERVICE: PERMIT NUMBER: e a - ,,-'-r,'„ ;' <br /> ❑SEWER 6EPTIC L.^fiW 7 0 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) : `- ' :,��� <br /> AREA TO NEAREST SQUARE RE FOOT: 0 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) � `' , , - : <br /> BASEMENT: 1ST FLOOR: ,.( a ® � <br /> g 904 i° ,, TOTAL SQUARE FOOTAGE: 4, n $ a� :- <br /> t <br /> 2ND FLOOR: 3RD FLOOR: ) -1 5 / 1 <br /> (� at8,i. � - K -3v `-ar.� +sa1 <br /> ESTIMATED CONSTRUCTION COST: r . .t <br /> (Please round to nearest dollar) ��[��4F <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? ❑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 ,7 <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 ❑Don't know <br /> 7. Is this to correct a violation? } ❑Yes . 'No <br /> lO { /3 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 5� (� (Continue on Back) -► -► <br /> ,� . 00� <br />