Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O ER NAME n �c � <br /> d �4 - ,3c 1`h ❑Zoning Status;CUP; <br /> OWNER DDR s ber,Street,Ci �, tat ZIP) Deed Restriction;CSM <br /> a -R t • rcp'jlVU Vol lu^ Variance(# ) <br /> 'HOME PHONE CELL PHONE E- AIL ADDRESS <br /> We (D i f i _-.11 A • • ,.....it.f, 0 1►I ''❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATICNj and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdaneco.dane.wi us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL py ��gg--��{ /- / frontage drawn to scale. <br /> NUMBER ��//�(Q I nC�`U ' L `' <br /> TOW HIP: �� SEC ION: <br /> `-1: 7'.-]: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits <br /> (public,private) <br /> PROPOSED PRO.IFCT INFORMATION STAFF REVIEW <br /> Pae4CT DESCRIPTION: <br /> ' ( \i-orc ` hlfM (3--)4 1 i Zoning District <br /> This project is a new bu din or structure.❑ P 1 9 ci Permitted Use?, ., <br /> 7This project is an addition/alteration to an existing building or structure. <br /> ANITARYSERVICE: PERMIT NUMBER: la Rural Address <br /> EWEREPTIC (new/exig} <br /> HEIGHT IN FEET: t�t NUMBER OF STORIES: (Not including basement) <br /> I Zi Wetland/Fl0®dpiaitl/ <br /> AREA TO NEAREST SQUARE FOOT: w i1oCeland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 ErosionControl permit <br /> BASEMENT: 1ST FLOOR: L9.I <br /> l TOTAL SQUARE FOOTAGE: ( lopes,disturbance, <br /> • fiNing/access) <br /> 2ND FLOOR: 3RD FLOOR: OD/ _ (` j <br /> !(v •µtai R t � a rte. ;k'`t. <br /> ESTIMATED CONSTRUCTION COST: 2 2 2 2 2 2 $ X71 ath 1�aiteh � t g, <br /> (Please round to nearest dollar) �P (/ <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? Des ENo ❑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 2No <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) Elves rgiNo EDon't know <br /> 7. Is this to correct a violation? s No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) 2 2 2 <br />