Laserfiche WebLink
.ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> I h6m( hart <br /> OWNER ADDRESS (Number,Street C• ,State,Zip) ❑ Zoning Status;CUP; <br /> Deed Restriction;CSM <br /> 7 icr a rr h 1 I l b f 1 U-- Variance(# ) <br /> HOME PHONE CELL PHONE ���'� E-MAIL ADDRESS /' <br /> -- 1 55 D--3q` fit- c~ Q( � GO/ ,Cc�m LI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> �+-rv•--_ N A ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE LI 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.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> [3:1 <br /> NUMBER C ) 0—cA 3a`{a� ,CS"1 frontage drawn to scale. <br /> M <br /> TOWNSHIP: SECTION: <br /> b(l S. I '/a: '/.'/a: ❑ Driveway permits <br /> ADDRESS: n (state,county,town) <br /> CSM: `e t. Kt I i N I U e C t- 1"%G I( 1 L� ( W I c�J l� ❑ Sanitary permits LOT g i SUBDIVISION BLOC OT <br /> bKi243 d es fr.k. U � (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: z ,' ° 5 � <br /> -1-[ t Ci.b1-)VQ l 110U-(•4 001 1,JI /0 N9 C rikixQt <br /> This project is a new building or structure. ; <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: sue 3 f ®r <br /> PERMIT NUMBER: �, �'C� i �^ �`' .� <br /> ❑SEWER thEPTIC s <br /> a � +ti , ' 4 - <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - , -- , x•AREA TO NEAREST SQUARE FOOT: t� , €� ( -�� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' ns <br /> BASEMENT: 1ST FLOOR: e 3 >1 p <br /> 4, TOTAL SQUARE FOOTAGE: 4, , �t- ,,+� -i <br /> 2ND FLOOR: 3RD FLOOR: - � <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ "♦ -* ♦ .- ♦ $ 4,0E0 q � <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? ❑ EsNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? JYes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes gl 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 'J No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► ♦ -► <br />