Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 2 '1- - <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS City,State,zip) r� _ Deed Restriction; CSM <br /> qr fj/;L�5 `8 r- /� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1614o At q J J Lv;74),-,A 4• ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> AV 3cr. '0 S r-i&iJ 1-/ rZ <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Slj,—4i"- Al4,0.... W <br /> PHONE PHONE ❑Site Plan approval from <br /> 4' cj5 z) 7d applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> /6,Nc.So w�,o�. w( 0 "^/i''"`O4❑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 /> ❑PARCEL 60 a/e,s/.Z,ivy-q e,0.7 frontage drawn to scale. <br /> NUMBER f <br /> TOWNSHIP: SECT! N. <br /> L8 r v i`.-1 -5t--"" %/4: i 2 ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> S,5"if ilri,t.5 re() gip,CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION . <br /> 37"AttREYtIW <br /> PROJECT DESCRIPTION: <br /> 10El c-b7.ee"- o � �F. <br /> P Cf ,or�tng bOitcrct <br /> . ❑This project is a new building or structure. [I Permitted Use? '„ <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: D RtitalAddress <br /> r- EWER JEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ■ fir / C1 Wetiand/FloodpiaiN <br /> AREA TO NEAREST SQUARE FOOT: Shbreiand-(attabhment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , ,,r. <br /> BASEMENT: 1ST FLOOR: hrosioncontrot permit <br /> /76 4, TOTAL SQUARE FOOTAGE: es,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: !-- (((liCt BCCe S) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ c, and avail pie options. <br /> (Please round to nearest dollar) $ / is-es-c> <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ❑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 ON <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? Elves ,No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -► <br /> 545-112(4/08) <br />