Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> BA 1 1 S� Nil ,Zoning Status;CUP; X I <br /> OWNER ADDRESS (Number Street,City,State,Zip) / Deed Restriction;CSM <br /> (�(p fit(�i 1/1(�h(l r t' ' 1^ M idd I 'c n, Y V Variance(# ) /, <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS ,5 <br /> (14$-55(r °039t1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 4 <br /> AGENT NAME CONTRACTOR NAME ► n <br /> Site P ,• '• uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS •0'-II/septi ■ <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks C3/3 D o <br /> PHONE 1P1 PHONE A Site Plan approval from 4-\I IA township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> titFloor plans to scale <br /> // �� <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Q PAR EER 038/0102{ 411 -na3 i-9 .R`1 O. g' Oi frontage drawn to scale. <br /> TOWNSHIP: SEC,T}��J (^ /• In <br /> Driveway i OF NI ldd I�-;-o (J / '/4: > '/4'/4: j(�Driveway <br /> ADDRESS: (state,counntyty,, <br /> j 1 <br /> Lel(0) FfiLY hC)(ne CA' Sanitary._ 's <br /> CSM: LOT SUBDIVISION BLOCK/LOT _ (public, .z13 <br /> �� 3I 1 0r 1N oio <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: <br /> C h t G ice() Ct /D /l`�/ <br /> 6P 6 r S Zoning District <br /> . -tis project is a new building or structure. %Permitted se? / �� <br /> This project is an addition/alteration to an existing building or structure. G I p( Cos ' <br /> SANITARY SERVICE: PERMIT NUMBER: ii Rural A• <br /> (EWER EPTIC (n <br /> HEIGHT IN FEET:h Z/ NUMBER OF STORIES: (Not including basement) Wetland/Floodplain1 <br /> tX Shoreland r(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Eros,ionControl permit Ai <br /> BASEMENT: 1ST FLOOR: �{ <br /> 1 Y I C i , TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, 4 <br /> te _, tilling/access) ' <br /> 2ND FLOOR: 3RD FLOOR: <br /> (K)/� se) -r 1 y <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ¢ nd available options. '1 <br /> (Please round to nearest dollar) $ -lel S, o 3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes [ to ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o 6on't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ILK <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) 01'es 9 DDon't know <br /> 7. Is this to correct a violation? [Yes Rgo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112 141081 <br />