Laserfiche WebLink
• <br /> • <br /> • <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 4 dd M fio v''A 1 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 30 0 a 5K c c.r• fZ c.) Sown os y- W j-3 S-3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (90. -t4-1 i L, --) I - - 8 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> "Zji9}J 4-4 ol' no-ft) ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES of well/septic <br /> tN U,D3 +i w 4 L . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 'Do cc nszs i- Q.7. S5S3 . <br /> PHONE PHONE ❑ Site Plan approval from <br /> (0Q _ q(1, —7044g applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: property <br /> /nONING: ACREAGE: ❑ Elevation of proper <br /> D PARCEL <br /> NUMBER b 1 a/ 91 O ID(-CeEio-o A - 1 "Z , ( frontage drawn to scale. <br /> TOWNSHIP: SECTION: �y <br /> 1"E <br /> .-66454o ( 0(f 1/4: �� 1/41/1: 5 LL) ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 000 5K c-0,-- DJ ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> L (public,private) <br /> PROPOSED PROJECT INFORMATION -, <br /> PROJECT DESCRIPTION: - <br /> u a; <br /> f-..7. -Ty., �s 4 Yai? - . ' <br /> <hro o Soo - �B^c /3 -- `0,ch, 0 `T t► y 3� i <br /> i <br /> . ❑This project is a new building or structure. ,4 <br /> at This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: s o _ s . <br /> ❑SEWER E SEPTIC ; . e <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) � ; <br /> Mfr e :- a 6{ �' <br /> AREA TO NEAREST SQUARE FOOT: " -4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) :; <br /> BASEMENT: 1ST FLOOR: ' -, ® e � � <br /> 1 q + TOTAL SQUARE FOOTAGE: ,, 1 � ,,,p <br /> 5 ' <br /> 2ND FLOOR: 3RD FLOOR: q ) y <br /> r $ ; �s <br /> ESTIMATED CONSTRUCTION COST: 'rr�� 4 , :, <br /> (Please round to nearest dollar) —. —I. -4. -1. —. -4. Q., V <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1. No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ErNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? iiil Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes CNo <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 &IDon'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 />