Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> s� bus 7 ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number.Street,City.State,Zip) • <br /> /6/2_ Syr p f-W ire iv Ss Irrro Deed Restriction;CSM <br /> c ' <br /> 4"-3 s'q . Variance(# ) <br /> HOME PHONE i CELL RHO E-MAIL ADDRESS <br /> F3q- 3¢ b Sr 's • 5-,---- i/ l l.t1r sr e Cli 4lrf£r , per ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -'rc Lit'S rout 6cir—hdw's LL(❑ Site Plan including location <br /> AGENT ADORE SS CONTRACTOR ADDRESS 2 of well/septic <br /> 9/0 e6.,,4- a te-t -7c et- <br /> (City.State,Zip) (City,State,Zip) ❑ Setbacks <br /> ��1-7, <br /> PHONE PHONEJSGw l'/-/ ❑ Site Plan approval from <br /> ‘7d ' ?r•- c3 rs--- applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> e li y-D �� f cc r e;II t A Ar . _ c, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEE. L ,3 - ?"0.70 - 4 4-_/ f frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /Owry .0T er/S r c>, 1 ,2.5--f-/1 '/4: fire l,/ WA:: -5-"`/ ❑ Driveway permits <br /> ADDRESS: (State,county,town) <br /> /-, .5-5-' Cree./i,V4-y tea <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT . (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ii-- p p 1�"c c c.L 0 Zoning mond <br /> IA his project is a new building or structure. 3 Permit*,Uses <br /> we his project is an addition/alteration to an existing building or structure. - t1 <br /> .ANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> SEWER EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> J 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) t <br /> BASEMENT: 1ST FLOOR: IrY08iOLn''OftttY� & <br /> 3n , TOTAL SQUARE FOOTAGE: i •(slopes,disturbance, <br /> - <br /> 2ND FLOOR 3RD FLOOR fi3brtg/ace ) <br /> 33 0 ReView Location Survey <br /> ESTIMATEC CONSTRUCTION COST: ♦ ♦ �-► ♦ ¢� �/ 3� and available options. <br /> (Please round o nearest dollar) �P G3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes rJ No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? []Yes E No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑Na 7 <br /> V <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a locator survey required? (see reverse) ❑Yes El No El Don't know <br /> 1 7. Is this to correct a violation? :Yes allo <br /> APPLICATION MUST BE SIGNED <br /> 54545-112 2(4108) >ku O. f/. c� (Continue on Back) -4► -. --t. <br /> I <br />