Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> DCANNER NAME <br /> EY N ) 0) /Te/4 CY ❑ Zoning Status' aP; <br /> 575DRkou^\eptbt itY.SSaj ip) LE / C� , D /, `) n50��1 ari a(# ) <br /> 1�1 /Ya • LI- �1 J) (�i ed Re ' tion; CSM <br /> HOME PHON- �{�, CELL PHONE pq E-MAIL ADDRESS <br /> •bg- • Q5Jv-1 6o 5 , 1 DI Sit Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sit Ian including location <br /> AGENT ADDRESS '/ CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE / ONE CI Site PI pproval from <br /> U- PH ap ' able town <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor ns to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREA E: ❑ Elevation of property ,_ <br /> ❑ NUMBER o c,7/ _ 7q L- <br /> 175 C' ,C. - / i•,A frontage drawn t ale. <br /> TOWNSHIP: SECTION: _ / <br /> '*--E t a in o� / 1/a: '/a'/a: �� ❑ Drive permits <br /> ADDRESS: ^1 I I ‘\ (staff,county,town) <br /> 5(ci r dE`n IZ�O � c L i 513":>--3! ❑ Sanita ermits <br /> CS . • ••9 LOT SUBDIVISION BLOCK/LOT (p u c,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIE' tip <br /> PROJECT DESCRIPTION: <br /> I onin14,Oilptne <br /> . ❑This project is a new building or structure. . Permitted Use?: <br /> ,his project is an addition/alteration to an existing building or structure. <br /> 33 <br /> SANITARY SERVICE: PERMIT NUMBER: ❑,Rural " s ' ' ., <br /> ❑SEWER ❑SEPTIC (newt,x istin r) a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/F ' dplatnta ; <br /> •AREA TO NEAREST SQUARE FOOT: M1oreC ® (afellmeTl�(s <br /> (Outside dimensions including unfinished area, attache garages and above grade decks or porches) <br /> ❑ EroslonOntk permit <br /> BASEMENT: 1ST FLOOR: ! 5 J g , ' t <br /> qi/ 4, TOTAL SQUARE FOOTAGE: + (SEOpes, , 5irb ce* <br /> 2ND FLOOR: 3RD FLOOR. IllingfaecesS)/ 7 ? 0 Revtew 1=aeatrah Sunte <br /> ESTIMATED CONSTRUCTION COST: ll (Y�0 O and available a)?tl4ns `� <br /> (Please round to nearest dollar) ♦ ♦ -+ ♦ ♦ ♦ c)/ V lJ ., <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? aYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 32k/es ❑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 , o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> --g <br /> 0 0q APPLICATION MUST BE SIGNED <br /> I (Continue on Back) —► —► —► <br /> 545-112(aioa) <br />