Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION„z,' ......;$ _? . "; ,„, ;. , _ _ w CUSTOMER TO PROVIDE <br /> OWNER NAME s" <br /> L r I C- F4 'f' OS w 0 Y'7`"I'1 <br /> OWN RADDRESS (Number,Street,Cit State,Zip) ❑ Zoning Status;CUP; <br /> �f ' ,4 i y / p e€r-reld / S-�S--s/ Deed Restriction;CSM <br /> 77 bb �`' /�1 (J (/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / <br /> ‘07-5-75"-?0 3�` /Cai AS d Lam! 'i- a 20 le 0 WI ❑ Site Plan drawn to scale <br /> AGENT INFORMATION.-. CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME , CONTRACTOR NAME <br /> ,E.A-1c_ ,/ ck 'c I\St 4 04-1L h ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> X4/6 Mw e <br /> (CU,State,State,Zip) (City,State,Zip) / ❑ Setbacks <br /> Ue-e i-�-r /c/ w t <br /> PH PHONE � ❑ Site Plan approval from <br /> o 8 35 <br /> 3-75--3o 3 applicable township: <br /> E-MAIL ADDRE E-MAIL ADDRESS ESS <br /> 7-7,,i yls lei s— 2 Ro ),Cod ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.usn ❑ Elevation of property <br /> �I PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P y <br /> 1�°�' NUMBER v 2`-/'a7/Z//? -$)-4a' 'QS� frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 0 e e c •C lei A' £ -1/4:5,w %1/4:--5E SW ❑ Driveway permits <br /> S/L )241,..)y (state,county,town) <br /> ADDRES <br /> 7 t./ , ❑ Sanitary permits <br /> CSM: �� LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> - <br /> �� 3-' TA EV t <br /> PROJECT DESCRIPTION: ' `'. :,':',,:-.:',..,=.5:::° <br /> a ch ed -Q <br /> ❑This project is a new building or structure. c, a` 71 <br /> ,This project is an addition/alteration to an existing building or structure. • : .'.3 <br /> SANITARY SERVICE: PERMIT NUMBER ii e° - :1 <br /> ❑SEWER XiSEPTIC ` � .-4 <br /> HEIGHT IN FEET NUMBER OF///STORIES: (Not including basement) <br /> p�'; z v <br /> AREA TO NEAREST SQUARE FOOT: . - r -a <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) �' : <br /> BASEMENT: 1ST FLOOR: e - e <br /> h1r4'o1 ,j. TOTAL SQUARE FOOTAGE: , - ► s ,, <br /> 2ND FLOOR: 3RD FLOOR: � � ��` - ,.° . <br /> ESTIMATED CONSTRUCTION COST: a d d. .4,1 <br /> (Please round to nearest dollar) "� "� "� --10. .,, . .a .:. _` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IN No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 4 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes CZI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4 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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes gsNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —o -♦ <br /> 545-112(4/08) <br />