Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com IMZEMMEMEMIZII <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE. <br /> OWNER ADDRESS (Number,Street,Ci , tate,Zip) ❑ Zoning Status; CUP; <br /> Z o yS ye4 , rya,-s4 // w1 Deed Restriction; CSM <br /> , <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS - Variance(# ) <br /> 33 _ iG / ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE�'N/T�/�AME CONTRACTOR NAME <br /> - f SC 4 S e/ e'er r 444 S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS g <br /> of well/septic <br /> /3 sy �3k �� P � P <br /> (City,State,Zip) ,� <br /> (city,State,Zip) �.�--� U Setbacks <br /> OT Cc- �i Q a (A) , <br /> PHONE <br /> Cool PHONE ❑ Site Plan approval from <br /> ` V-3 & S applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT P/AjRDCELNUMB R: CURRE Z ING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER 1.' a ) 1 — �2 — s�c frontage drawn to scale. <br /> TOWNSHIP: SECTION: • <br /> S:t h r r a∎ r r' e 1 Y 1/a: N w '/a 1/a: p w ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> Zo vS / C /4 /ea.1 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> 1 Z 7 y (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAI F IZEVIEVI <br /> G a/ 4S Zoning District �� " <br /> a This project is a new building or structure. <br /> Permitted Use 7.= <br /> Li This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: Rtararas" SSA" LL , , <br /> ❑SEWER ❑SEPTIC (n i iii <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ° <br /> /G "(9" / Wetlatnd/Floodpl in! <br /> AREA TO NEAREST SQUARE FOOT: Shorerand atfa ( � <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1�ErOSIOi� (3 [t QI pG�rR1lt <br /> / 2 0 0 ,l TOTAL SQUARE FOOTAGE: j i (slopes,disturbance, V O / <br /> 2ND FLOOR: 3RD FLOOR: firrfng/accSS) " j <br /> ESTIMATED CONSTRUCTION COST: Review Locatio Survey <br /> (Please round to nearest dollar) '� "� ♦ ♦ —► ♦ and avairabre a`bons. , <br /> /f000, a v - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes iaiNo ❑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? ❑Yes ItNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Li Yes UNo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey requir-.9 -e reverse) U Yes El No U Don't know <br /> 7. Is this to correct a viola '.• ❑Yes J No <br /> 4/0, D 0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) --ti ♦ -p <br />