Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ( <br /> ? 3:Q - i'Aucer-r,/5 3Arn'S s4) <br /> r-rf'f ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction;CSM <br /> ta(o CrwNr z4 S+ /11/1-D 404 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ■+__3V----//0 PA7va's/S '' A/s . IE4 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAM <br /> TC,rle , /A/serk/ �ze. /CP04 ❑Site Plan including location <br /> AGENT ADDRE S CON RACTOR A DRESS of well/septic <br /> W Bo)'( /ItoR$e._ kb 1-JQjo?1 f /1102Se frm <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> aa nlrrfr- . Tic/ Pc/"I rrr , _r 953- <br /> PIONE PHONE ❑Site Plan approval from <br /> ,08 --7y5 85-60o)e-"PVC-gam°-g"'o applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale o 1.1a.,1‘ rxTa2sin , • LA t a'Avia)e hIa S/o orb HV.(c),4 t ❑ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> NUPARCEL O 7- frontage drawn to scale. <br /> MBER o/o7a7-�aa-ay ' -o /2-(�� s ' / <br /> TOWNSHIP: SEC)O <br /> 1/4: 1/41/: ❑Driveway permits <br /> �tx-AS^� S (state,county,town) <br /> ADDRESS: O <br /> /1 SAS >c C 0 O(G 1 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION LOCK/LOT <br /> J3 3 (public,private) <br /> oak. U� �smr��, 3 <br /> PROPOSED PROJECT INFORMATION STAFF-INEVIEW <br /> PROJECT DESCRIPTION: <br /> 47E N' GpirSne vc TrGY✓ ❑ Zoning District <br /> RThis project is a new building or structure. Cl Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUIal Address <br /> � <br /> EWER IZEPTIC / 3 _ yy .- 08 7 (newfexistin ) <br /> HEIGHT IN FEET: r NUMBER OF STQRIES: (Not including basement) <br /> vv� D. Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ EroS1oncontrol permit <br /> BASEMENT: 1ST FLOOR: <br /> ,1ter ( C7 + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> +#'r l , J C.3 a s�� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 119)1-- Q' CZ ( ( U Revi ew Loc n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --► ♦ -► , %. �tJ/� and available options. <br /> (Please round to nearest dollar) $ t. / C71 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Et•o <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) ❑Yes �lo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Eto <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i -► <br /> 545-112(4/08) <br />