Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 4/O fS <br /> OWNER A D (Number,Street,City,State, Zip) ❑ Zoning Status;CUP; <br /> L 4 442' ,€L2 - �Y1 537/g Deed Restriction;CSM <br /> Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> s—S13 6'5-.2 O. V ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER °SCr-23—f - / c. - frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> evR k� CeIO-Z31t.- cfZ-70-7 ?_ /o 1/4: Sit/ 1/+1/4: ❑ Driveway permits <br /> (state,county,ty,town) <br /> 35'99 SearF �'D <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: E ` �, <br /> . ayhis project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: � � <br /> ❑SEWER SEPTIC -� e gals <br /> HEIGHT IN FEET: , NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: T <br /> 2.S0 <br /> 1 TOTAL SQUARE FOOTAGE: j G ®° x <br /> 2ND FLOOR: 3RD FLOOR: s <br /> s � a <br /> ESTIMATED CONSTRUCTION COST �, _ � » _ ��,4 f <br /> (Please round to nearest dollar) -4. '� ',��' ,44t <br /> API'uc:A°rtai pee <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 <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 121 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545.112(4/08) <br />