Laserfiche WebLink
a, <br /> ZONING PERMIT APPLICATION www-countyofdane-com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1111�-th SerSCK i- n1 to e t 1 e L. A l+en bw{ j ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> ' ( 3 Tw in Val■ey IZvack j Variance(# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> 01.4)- -- -530 , ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> C.USrvrc Cons AYIket 10n LLC.. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> )110 e1mwax4 C I ale LiJ s+- <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Crass IP Ict,nS Lk)i 5 3C <br /> PHONE PHONE ❑Site Plan approval from <br /> 1 cl -a-CO( applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> LICOSN1AAN) "'CN 4ZTf Z.OFT ❑ 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 /> ❑PARCEL O38/O1o8_113-gla0--1 R_ ,Li a8 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 11'1 t dA(e tor\ 11-1-g 1/4: '/4'/: ❑Driveway permits <br /> (state, county,town) <br /> ADDRESS: <br /> Li tLL j t.& V aI\P IYl l c 1,e kOr, i s 5',Slo d- <br /> `( i ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> I:00 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> AI e t Garet?f. c cLc d .0 h0u: t_-- ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> [this project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEVVER I " /EPTIC r fr • (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ie (it t" ir0 EAl t 4' 44 G" 4.0 ei-K I ❑ Wetland/F000dplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) r-, ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> �` disturbance, <br /> TOTAL SQUARE FOOTAGE: ,$, (slopes, <br /> �-{ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> — --- LI 0`0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ Q �� O(X� and available options. <br /> (Please round to nearest dollar) �V % <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lEo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes o ['Don't know <br /> 3. Have Y ou talked with the township about your project and are they in agreement'? ❑S'es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ©r o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#/Q pi/ ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dies No �n't know <br /> 7. Is this to correct a violation? ❑Yes QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ -■ <br /> 545-112(4/08) <br />