Laserfiche WebLink
' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW r3- ••ME <br /> .�il,� a- . C 7 I / '' ❑ Zoning Status; CUP; <br /> OW =ADDRESS (N ber,Street,City,State, Deed Restriction; CSM <br /> 7 g f ra,' v�e� •�( ,r U'Q.fro ) W. S �3C f,3 Variance(# ) <br /> H•ME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 S .r c; 0 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGE NAME pp CONTRACTOR NAME 2 1 I <br /> Gj e v'p 1 G A E xid r-eS Eivci{�.p S I- u /Ct i--S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 21) ( C HT 7).) <br /> (City,State,Zip) (City,St te,Zip) ❑ Setbacks <br /> PHONE PH ! ❑ Site Plan approval from <br /> 6,,$) `( ; 7 7 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL a j / ('� j. frontage drawn to scale. <br /> NUMBER r O J D(�JD�� d 7�- s c' I� 1 1 �• DU� <br /> TO N HIP: ✓/ SECTION: <br /> Uk r 0 /1) a D 7 1/a: S E Ya1/a: S 1nJ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> �U r l l n ❑ Sanitary permits <br /> CSM: 5-'9 LOT SUBDIVISION BLOCK/LOT (public,private) <br /> - PROPOSED PROJECT INFORMATION STAFF REVIIEW 11 <br /> PROJECT DESCRIPTION: �� <br /> ❑.Zoning District N i• <br /> . ❑This project is a new building or structure. a Permitted Use? <br /> MThis project is an addition/alteration to an existing building or structure. ' <br /> SANITARY SERVICE: PERMIT NUMBER: ,LIF Rural Address , <br /> ❑SEWER SEPTIC L,Q Hd .e.. r (flew/existing) <br /> t <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3 •V,e -e I Zit Vi etland/Flat dptai <br /> SFhoreland (attactimen) ; <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: EI'OS1oneQntr©l p rfnita <br /> X v U gr 1 TOTAL SQUARE FOOTAGE: j (Slopes, isturbance` <br /> filting/a cess} <br /> 2ND FLOOR: 3RD LOQR: <br /> 5 ❑=Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ c__ and available oPtion ,3 S <br /> (Please round to nearest dollar) / v ,, - ', °e <br /> l,,' <br /> f <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 L No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes 0 N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes JNo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 10 No <br /> \ \ <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) O <br />