Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 70S kt 7a,rk r7 f"o l'1 (It-5 kl l-e-1/ -Fa r,-e 11 n ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> , 70 SandrocJ led- Mt/loreh Wl 535 7z variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /V74 (tog Z/3, 9/Q fSh ll&rK/ o&,,na/l° (off) ❑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 3-01" �,(�F w 11/septic <br /> T i>cy 0 17 - t <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/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> El NUMBER No ,y a -90 s� (a R H- 2 5 , (a&. 7 frontage drawn to scale. <br /> TOWNSHIP: p SECTION: <br /> 11AL �U U �l h S a q '/4: %.,A: ❑ Driveway permits <br /> (state, county,town) <br /> A ESS: /� <br /> , a 70 . nU/'o G Rd A# Horeb kw 53572 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> /_ 'Q- i (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> R I bath add// t7 0K) (52-8 sq 1 1- ❑ Zoning District <br /> . ❑Thi project is a new building or structure. ❑ Permitted Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> FIEWER JPTIC ),. P" (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 142 A- / LI Wetland/Floodplain/ <br /> F - AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ <br /> ErosionControl permit <br /> 528 59 F-1- 4 TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: �c filling/access)2 U S y {t ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q� ����,��� and available options. <br /> (Please round to nearest dollar) $ >`'' �'U coo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes 1116; ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes !ENO ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [-es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ego <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) Lives EKo ❑Don't know <br /> 7. Is this to correct a violation? [Yes ❑No <br /> 545-112(4/08) • ckb PPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> ri <br />