Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 4-, ititi-it J clitck5ciAl 411 Zoning Status; CUP; r <br /> O NERADDRESS (Number,Street,City,State,Zip ^ S I Deed Restriction; CSM <br /> 6se1 4U5 /0i) �� ) ► w , s3 Variance(# ) <br /> HOME PHONE I CELL P NE E-MAILAD RESS <br /> 8 — `J 6-7-3 3 - y / qv /14'1 v��a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimension <br /> AGENT NAME CONTRACTOR NAME <br /> 42, ite Plan including locatiory Aesp <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ON Setbacks ''3 l® <br /> PHONE PHONE Site Plan approval from AA <br /> applicable township. //F--- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 1,1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> ❑PARENT PARCEL NUMB ^ ^ i CURRE TZONIN ACREAG Elevation of property <br /> PARCEL 17®j�'r. UY/� Z ��� 6 ¢ .ntage drawn to scale. <br /> NUMBER QQQ 1P 0 <br /> TOWNSHIP:A SEC N � / <br /> a � 1/4: N 6 %I : /l/ iti l,% Driveway permit <br /> ADDRESS: (state, county o <br /> O M Sanitary gig-- ' <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public 4 ' <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW -A PROJECT S,C��IRIPTION: //� / / <br /> (� I x Q x Ill C T CS 62-4, r '`� Zoning District ,`� <br /> ❑This project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. j <br /> SANITARY SERVICE: PERMIT NUMBER: All Rural -= <br /> FIEWER rt EPTIC (ne existi • <br /> HEIGHT IN FEET NUMBER OF STORIES:(JOt including basement)�, Z Wetlan• loodplaln/ dd <br /> AREA TO NEAREST SQUARE FOOT: <br /> ='-orelaa• (attachment) /V— <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) � f <br /> BASEMENT: 1ST FLOOR: I�q-�fOS10nCOntrOlpeRnit � <br /> t9 8 4, TOTAL SQUARE FOOTAGE: j (Slopes,disturbance, �/ <br /> 2ND FLOOR: 111,1 • • 3) 4%,11/la / <br /> 3RD FLOOR: �o D / <br /> .,,,,,';!. -eview Location Sgrvey <br /> ESTIMATED CONSTRUCTION COST: � <br /> �� O and available options <br /> (Please round to nearest dollar) $ 0 � (/I U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ON <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ONo <br /> 5. Is this project associated with a rezone/CUP/variance •e ' '.II .a.eal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse).... res ENO [Don't know <br /> 7. Is this to correct a violation? [Yes ONo <br /> A//2. APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) ) ♦ <br />