Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> I<KI OWNER NAME CUSTOMER TO PROVIDE <br /> Vt' (( S -Po.41NA ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Nurhber,Street,City,State,Zip Deed Restriction; CSM <br /> Z0 SHOE Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 668- {-0(Ad ‘08-(cm- a5)0 ' - P40M &64/1 c-• ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CL,Ellt-R �Lt, G--<p. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR AD RESS of well/septic <br /> 170 Btu,( 93 oz2 O <br /> (City,State,Zip) (City,State,Zip) . ll ❑Setbacks <br /> PHONE �HEoNE o A I W 53652 <br /> `� ❑Site Plan approval from <br /> (opg_ e4 - 7ô gel- -5-7c.c. applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane-wi-us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> n PARCEL NUMBER �10 67 a ( A—ex l %•-n frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> pv N( 1\l '/<: %IA: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2g K lie N sc Ua lkD Q Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> so-e,uRt3Im.1 13 u(t--D i t L, Z b X t f!;; ❑ Zoning District <br /> . EThis 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: ❑ Rural Address <br /> EWER EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ((Di-41" ( ❑ 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: 1ST FLOOR: ❑ ErosionControl permit <br /> 'Z0 0 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> TTT filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> -------- I 2.oc.Ili <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ ♦ I �bU 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 NNo ❑Don't know <br /> ['Yes 2. Is there a wetland or floodplain on or near the property? Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [ ]Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 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) nYes gg o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Ell o <br /> APPLICATION MUST BE SIGNED <br /> I (Continue on Back) — <br /> 545112(4/08) <br />