Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME I /�r t 1 <br /> (Ow _T'"/ ` Ov1Cti rK'—" ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1 n 6-5-9 £' J. ollci t° f` 5 Rd 13/(it 5 L "✓ .r-` .� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (0c'3 /37-'3Gg33 40E3 -Z25--917'r ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> �A ENT NAME CONTRACTOR NAME <br /> ea ii, L. r— ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> t( ) Qt.t41`) /r x2 ,/)' <br /> (City,State,Zip) _,,(City,State,Zip) ht v- ► ❑ Setbacks <br /> )3 co n c t,Jcl CJ r 5-35-0 7 c- , li i <br /> PHONE PHONE ❑ Site Plan approval from <br /> Goff —q 2 y r GO- applicable township. <br /> E-MAILADDRESS //// E-MAILADDRESS <br /> ' c- (�1L.� q l4iii2;). Co'- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: <br /> ��/ _p �CURRENT ZONING: ACREAGE: frontage drawn to scale. <br /> ❑ NUMBER 0,O/0006-Zi3-9000 1 / q 4 <br /> TOWNSHIP: SS EC N <br /> 2( 1/4:r7W 1/41/4: 5 L.) ❑ Driveway permits <br /> S: / �5 (state,county,town) <br /> AD RESS: <br /> 2Z1-I 71rv1,✓lCch. Rd ❑ Sanitary permits <br /> . CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION ;STAFF )RE IEW <br /> - PROJECT DESCRPITION: <br /> �ehj ( e P:‘,.--\/ I/ t& cc U Zoning <br /> District <br /> This project is a new building or structure. ❑ Permitted Use?' <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 13 Rural Address <br /> ❑SEWER ASEPTIC ]E Z1 I (new/existingYt <br /> HEIGHT IN FEET:/ NUMBER OF STORIES: (Not including basement) <br /> 3 `/z- ` ❑ wettan i*,-9dplaln/ 1 <br /> Shoreland (attat men) <br /> AREA TO NEAREST SQUARE FOOT: i <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ �rosi6nControl ool <br /> BASEMENT: 1ST FLOOR: Slp eS,distur�bance, <br /> �, TOTAL SQUARE FOOTAGE: j ,.f p.,, F <br /> 2( 3 "�L/ filting(aceess) <br /> 2ND FLOOR: 3RD FLOOR: ' / <br /> r �Y7 <br /> l I ❑ Review Loeafioi Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ --0 ,♦ 2_0 O �� 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 al No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes V)No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? SYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes El 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 xi No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> Fr I ()1 , I 171 ns--,or <br /> APPLICATION MUST BE SIGNED <br /> - (Continue on Back) -► --► <br /> 545-112(4/08) tP <br /> I `'f-7Nn • v <br />