Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER:INFORMATION .:r , . .; 4.1,;;+ "';V:: - :w' C +TOMER TO PROVIDE <br /> OWNER NAME <br /> /6/7111,. c-Sl /4'-0-7(1 L Z ing Status;CUP; <br /> OWN ADDRESS (Number?,Street,City,State,Zip) ed Restriction;CSM <br /> 049c?Iii `rRA/L OF--4) R.L2 t1E2-doti-/ to 5-35--9-3 ariance(# ) <br /> HOME PHONE CELL PHONE i E-MAIL ADDRESS <br /> elle- X.5-8 4`4-5--,SCR 3-8 gas ,BU fLritt/LT c'f lier . UE� Ite Plan•drawn to scale <br /> AGENT INFORMATION.-: .' •, CONTRACTOR INFORMATION, ' ,, nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> $I-'r/3c1►i--**ra421- BG/► 042-.5 S' a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 33/S— L /(11K/*i/C/a i <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> 4/ IfQ/Scvv W/ s'3?d� <br /> PHONE PHONE i_ ite Plan approval from <br /> c 4l(-2Q)0 pplicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 8$57'Bdit_T/►tl4T'@c 7 .A/CT Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.usn ievation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONI ACREAGE: P p y <br /> LI PARCEL 06,0' 1 1^ <c© -O ,„ ( 15, 7 rontage drawn to scale. <br /> NUMBER v�lam+ J T <br /> TOWNSHIP: C.. 1 SECTI N: . 11 <br /> . - t( QI 1 '/a: E 1/1/: N -J riveway permits <br /> ADDRESS: 1 1 �� t state,county,town) <br /> c i / 1-` Q‘ U kk e 117--- Sanitary permits <br /> csM: { 7S Q LOT I SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION -4F <br /> PROJECT DESCRIPTION: �'!?.'1:: :. ` � <br /> a�x3 Y A EV ctso -46.g v4 8 , <br /> L <br /> 0 This project is a new building or structure. _ ® '' .- ? � .°' , <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> P"'-',' f -`4 ��` <br /> SANITARY SERVICE: PERMIT NUMBER: �ss� <br /> ❑SEWER ❑SEPTIC AM1 � � �'' 1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) = 5' <br /> 12 to rater n tirfa r ; <br /> ' , 0At�ir ,�1 { <br /> AREA TO NEAREST SQUARE FOOT: t <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 6 tl i � - <br /> BASEMENT: 1ST FLOOR: , .„.,,,,;'V-,sKi*'..... ,e;z.: ,- <br /> �/ i' e si A m,, TOTAL SQUARE FOOTAGE: j e ,4 , <br /> 2ND FLOOR: 3RD FLOOR: <br /> / <br /> e * 7 <br /> ESTIMATED CONSTRUCTION COST: a :Y 0 e 7i <br /> (Please round to nearest dollar) -► -► -► -► -► /e--). <br /> / / 000 ,;, , a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ki No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 Yes ❑No LI 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/ one) <br /> 6. Is a location survey required? (see reverse) <br /> CJ N ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i -41. -► <br />