Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID <br /> OWN:- Oltrine.. /� <br /> .,./ i <br /> c k S u as 1, Zoning Status;CUP;O -A (Num/berr,Street,CI,State, ip) }- Deed Restriction;CSM -1-5 -5 <br /> v�/ ) no( r State, c I Ire_ O h , Ik -'J Variance(# ) <br /> HOME PHONE CELL PH°O�NE II E-MAIL ADDRES' `, <br /> (o6 t-2(.%-(735 Lb b-141 X ( 91, k .� U. p"6 't( / i'M l'I. C-1344 Site Plan drawn to scale <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION and includes dimensions `` A,ee- <br /> AGENT NAME CONTRACTOR NAME dn <br /> Site Pla .,_ding location ��JT <br /> AGENT ADDRESS CONTRACTOR ADDR S 1 of 'r'/septic <br /> 111 <br /> 30 <br /> yY / 3 <br /> (City,State,Zip) (City,State,Zip) Setbacks � 5- / 0 <br /> PHONE PHONEite Plan approval from , Ill <br /> applicable township. P'' 4- <br /> ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale / /1 <br /> PROPERTY/LOCATION INFORMATION (hitp //accessdane.co.dane.wi.us/) / <br /> PARENT P N BE/�: -7/'�/ C7EONR7 ACREAG IevatlOn of property D NUMBER 3 �r y frontage drawn to scale. <br /> TO HIP: SE TI yPJ. I ,• , <br /> 1\1 b°l t _ '/e: N '/%: S(∎ Driveway permit <br /> (state,coun,4 <br /> ADDRESS <br /> 5-'ii7J 'mar'l . 61 , O YeOj oJI 1n1 35—F5 <br /> Al Sanitary_•-ir.Is <br /> CSM: ��^ LOT b SUBDIVISION BLOC +^ (publiff <br /> PROPOSED PROJECT INFORMATION X/ STAFF REVIEW <br /> PROJE. r ESGRIPTION: -. N 1 r <br /> `r 1 A be ■ A • X /.' Zoning District K— , <br /> This project is a new building •r structure. 3/3 <br /> ? <br /> This project is an addition/alteration to an existing building or structure. %Permitted se./� C , CQ.o <br /> SANITARY SERVICE: PERMIT NUMBER: t ,Rural A' <br /> EWER EPTIC (new/ ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) r <br /> I letland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) /1�ErosionCOntrol permit ` M <br /> BASEMENT 1ST FLOOR: / /�! /�/ <br /> �i l TOTAL SQUARE FOOTAGE: l (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: J q/ A/l!/_u1 Review Location Survey ,�/` <br /> I <br /> ESTIMATED CONSTRUCTION COST: $ I O oo ■ W and available options. / �- <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes o :Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es EVo <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 F∎ o :Don't know <br /> 7. Is this to correct a violation? :Yes ►T o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) = = <br />