Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Dakota Gray 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,ZIP) Deed Restriction; CSM <br /> 724 Washington Rd,Edgerton,WI 53534 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)247-1041 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wellseptic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township, <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:f/accessdane.co.dane.wl.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: E]Elevation of property <br /> 0 PARCEL 0512-192-9110-3 R-1 0.71 - frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Albion 19 1/4: 5 W/4W/4. 12 El Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> 724 Washington Rd, Edgerton, WI 53534 <br /> ❑Sanitary permits <br /> CSM: 2,059 LOT 1 (p ublic,SUBDIVISION BLOCK/LOT <br /> n private) <br /> G <br /> PROPOSED PROJECT INFORMATION - . STAFF REVIEW <br /> PROJECT DESCRIPTION: • <br /> Utility Shed Li Zoning District <br /> . IN This project is a new building or structure. Q Permitted Use'? <br /> 0This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NL MBER: ' LI Rural Address <br /> EWER [EPTIC (new/exiSting) <br /> HEIGHT IN FEET: NUMBER CF STORIES: (Not including basement) <br /> 13.0 0 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) <br /> BASEMENT: 1 ST FLOOR: 0 trio roncontrol permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, ($topes,disturbance, <br /> filiing/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 600.0 C3 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options round to nearest dollar) -' "� ♦ "♦ -" ♦ 4,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 eet from a pond or lake? QYes aio ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes o �on't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [ Yes ✓JJo <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) QYes �lo r4Don't know <br /> 7. Is this to correct a violation? EJYes ✓'lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -i -+ <br /> 545-112(4108) <br />