Laserfiche WebLink
i\v;:\A -1&( 1 4 1 .\--\---All.,:11,r,„- <br /> n G(-1) \C,i\�h-Q \ .,,,,\ A\A\ <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.couofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER E <br /> U- ilk ` 1-z- ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number :.-t.City.-:te.Zip) c ' Deed Restriction;CSM <br /> �' •�i t.,!_l c ' � 2 tilt ■I S �V Variance(# ) <br /> HOME PHON C PHO L•IORE '' <br /> cD -a.s.-1 • "6 %O`' .u33 ..e Wooi ec-D t ■C),C&V". ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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.us/) El Elevation of property <br /> ❑PARENT PARCE NUMBER: \f (�� �}�CURRE TZONING: ACREAGE: frontage drawn to scale. <br /> NUMBER t• )( \ , 4�] ��Jc± J -1c3I.CI <br /> TO WP: SECTION:_ <br /> \, ri� -. & "l '/,: St: WA: SF- <br /> El Driveway permits <br /> ADDRESS: (state,county,town) <br /> P--Al GSM: <br /> SCV3 \RI LoTI \ �UBDN \� : . o� 3q ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PR• CT D SCRIPTION: I •__ <br /> NIS \St !I ► �'.�,!_ ■ �1 ♦ ► ❑ Zoning District <br /> . ❑This project i a n`w building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> Y SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> • <br /> FIEWER nEPTIC (new/existing) <br /> EIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ EIOSiOnContro)permit <br /> BASEMENT: 1ST FLOOR: <br /> 4 TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ O: , �[jO�. m <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es EiVo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es Dlo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Y ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ao \\t q SQ. <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ['Don't know <br /> 7. Is this to correct a violation? ❑Yes RIC <br /> APPLICATION MUST BE SIGNED <br />