Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> kI IBC"ET VT((IN ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 72.Z (-}IGt-IC..Pou6 1Q / 1.JI+JDSo� , t,•' ■ 5350)8 Variance(# ) <br /> H ME PHONE CELL PHONE E-MAIL ADDRESS 11 <br /> �� -35%- „ 3 SA t•A 170;.36 Q. j P412 2,-%°\ e-•,Flo%1 ,Cc'M ❑ Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sflc.c 4 G I LAtJ C.- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 0722 1-1 1 Gt4LA0 ) iK <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Wi r0 D9, % 1a1 535`1 , <br /> PHONE PHONE ❑ Site Plan approval from <br /> ( o8 -s- S----0-\-)c) applicable township. <br /> E-MAIL ADDRESS , ADDRESS <br /> \ U�a.�1 V%G\, - .,ceNoN'a•Co r,,> El 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 C9 1025A203 '(o PJ _-IA 0 , 15-7 frontage drawn to scale. <br /> NUMBER V� <br /> TOWNSHIP: SECTION: <br /> N,D‘‘,--) 0(2-.. .1/4: <br /> -1/4.1/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> L1 t-\C O GRts wA4 be . <br /> CSM: LOT SUBDIVISION BLOCK/LOT 1=1 (public, permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION : i STAFF REVIEW <br /> PR JECT DESCRIPTION: 1 ( 1 ,CNS <br /> . ❑This project is a new building or structure. Permitted Use? <br /> 51 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural' r�s i <br /> SEWER SEPTIC � � �� <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) `„ ''-w,v" <br /> kNe nld/ loodplainf ' <br /> Shand (atlaChment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) © E ontril ; ,-- <br /> BASEMENT: 1ST FLOOR: Iermtmit. <br /> 4, TOTAL SQUARE FOOTAGE: 4, I,,,,-.;disturbance, <br /> filn t. <br /> 2ND FLOOR: 3RD FLOOR: <br /> LI Review Locatl t t o <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ �Q _ and a{�i <br /> (Please round to nearest dollar) "�QC:Jy` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes gi No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 2No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ]Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1:ZI No <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 No ['Don't know <br /> 7. Is this to correct a violation? ['Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ - <br /> 545-112(4/08) <br />