Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> T� -� {� <br /> !VIn { <br /> t !ZO�tfl 24/re/ J !‘_ ❑ Zoning Status; CUP; <br /> OWNER (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> HOME PHONE CELL NEIZI f1&Aiiiv'S WI S75611 Variance(# ) <br /> Got 8 3' SO AD ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (Joi. kiNsoil Ca t-ft'y i f O- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> q8 5 U t'CWv <br /> (City,State,Zip) (city taCuzipk(r- �t � � f ❑ Setbacks <br /> PHONE PHONE 8 3 ❑ Site Plan approval from <br /> 68 5-75 — 2f 0 4- applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> LI 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 /> ❑ NUMBER 046/06 If -111-0)51 ILI • 7 frontage drawn to scale. <br /> TOWNSHIP: SECT ON: <br /> r�lCa fq�� C n np ,/4: <br /> ,/h: ❑ Driveway permits <br /> ADDRESS: 0 (state,county,town) <br /> 1511 4rou , oe Rd J°(Dukbh WI s?s-8 s ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION e BLOCK/LOT <br /> LS f 1`► I. GPI I , / 25 (public,private) <br /> PROPOSED PROJECT INFORMATION Re [ew , 3 <br /> PROJECT DESCRIPTION: <br /> dar'gSe C" , .,: : <br /> . ❑'This project is a new building or structure.P J 9 � �`�tted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural i 1 <br /> (SEWER J8EPTIC (newt 7 •, <br /> HEIGHT IN FEET: / NUMBER OF STORIES: (Not including basement) <br /> Shore {a ctt'm£ent <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) © ET,Si oonCon$Oe,; -4 4t <br /> BASEMENT: 1ST FLOOR: <br /> 24 y 3o 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> cl<R' © Review Location S <br /> ESTIMATED CONSTRUCTION COST: $ <br /> • f'O <br /> (Please round to nearest dollar) '♦ ♦ --► ♦ ♦ ♦ •p B aVallab(e ti 5 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [co ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes O.Alo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q e ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [l]�No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if no ) <br /> 6. Is a location survey required? (see reverse) o e❑Don't know <br /> 7. Is this to correct a violation? Yes Dko <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />