DCPZP-2013-00744 - Laserfiche WebLink

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1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ...... 2. Is there a wetland or floodplain on or near the property? ........ ............................... 3. Have you talked with the township about your project and are they in agreement? 4. Has there been a zoning permit issued for this property in the past 5 years? ........ 5. Is this project associated with a rezone /CUP /variance (petition /appeal # 6. Is a location surrey required? (see reverse) ...t,�/ ...... 7. Is this to correct a violation? .............................' ..................... ......---------- ............... ❑Yes ONO ❑Don't know ❑Yes o ❑Don't know [:]Yes o ®Yes ao (leave blank if none) ❑Yes F)No ❑Don't know ❑Yes Zlo APPLICATION MUST BE SIGNED 545 -112 (4108) (Continue on Back) ZONING PERMIT APPLICATION www.countyofdane.com r SUPPLEMENT to Web-App # PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE OWNER NAME n JOS60fl, ❑ Zoning St t UP; Deed Restriction; CSM OWNER ADDRESS (Number, Street, City, State, Zip) !s�-f3 STele R6 �EGo•v LJL 53S7S o,, J"� Variance (# ) ❑Site Plan dr wntp-iiwa le and inclu e96wns HOME PHONE C08-835-00!97 CELL PHONE Z62- 3�9-GS38' E -MAIL ADDRESS JREc.v+�n�S�csSF��rn�eDr''t AGENT INFORMATION • • ' INFORMATION AGENT NAME CONTRACTOR NAME ❑ Site Plan in ding location of well/ tic AGENTADDRESS CONTRACTOR ADDRESS ❑ SetbW.W (City, State, Zip) (City, State, Zip) ❑ Site Pla p val from PHONE PHONE applicaj�s iip. ❑ Floor pl�to scale ❑ Elevation o, fpr6perty E -MAIL ADDRESS E -MAIL ADDRESS PROPERTY/LOCATION PARENT INFORMATION (http://accessdane.co.dane.wi.us/) PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑PARCEL / &5o A -3 r, S 7 frontage wn to scale. NUMBER , ❑ Drive a S TOWNSHIP: Q , ® ^G SECTION: 1/4: 1/41/4: (stat n , town) ADDRESS: !'S`f 3 STO/z y7ow .,,i 21) Qe6Gc N WL 535-7'x` ❑ Sani ermits (pu i e) CSM: LOT SUBDIVISION BLOCKILOT l 0( ( • ' •' ' • - ' - ' STAFF REVIEW PROJECT DESCRIPTION: I 6-44ru l -,< t b /%f X f b r ``�/ ❑ Zoning istnct ❑ Permid Use? gThis project is a new building or structure. [:]This project is an addition/alteration to an existing building or structure. ❑ Rural Address SANITARY SERVICE: PERMITNUMBER: EWER EPTIC (new /ex r>I j ❑ Wetl plain/ HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Sh0 rtjlttachment) AREA TO NEAREST SQUARE FOOT: (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ Er0 ntrol permit BASEMENT: 1ST FLOOR: (O 7 Id TOTAL SQUARE FOOTAGE: + turbance, w ( filling /access) 2ND FLOOR: 3RD FLOOR: 2 S(o SQ f7 ► ❑ Re tion Survey and Vail a options. ESTIMATED CONSTRUCTION COST: (Please round to nearest dollar) "� ♦ '♦ ♦ ♦ $ //S D� �� -7 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ...... 2. Is there a wetland or floodplain on or near the property? ........ ............................... 3. Have you talked with the township about your project and are they in agreement? 4. Has there been a zoning permit issued for this property in the past 5 years? ........ 5. Is this project associated with a rezone /CUP /variance (petition /appeal # 6. Is a location surrey required? (see reverse) ...t,�/ ...... 7. Is this to correct a violation? .............................' ..................... ......---------- ............... ❑Yes ONO ❑Don't know ❑Yes o ❑Don't know [:]Yes o ®Yes ao (leave blank if none) ❑Yes F)No ❑Don't know ❑Yes Zlo APPLICATION MUST BE SIGNED 545 -112 (4108) (Continue on Back)