Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> o 'E NAME 1). .,� it e.5 I) i if lj- /D /1/ ❑Zoning <br /> O ER ADDRES (Number, eet,Cict ip) / 3S gt, Zonfn Status;CUP; <br /> I P , j� ,7e u j ji zr / 1 j, Deed Restriction; CSM <br /> [t J /V �L l� y Variance(# ) <br /> HOME PHONE C LL PHONE �j p E-MAIL, D Olt'�i �7 / -�/D t 4,c�/r {� 1' ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A ENT/�AME i f F CONTRACTQR_NAME n _ f J _ <br /> t (i t L I T-t d=� A4 / /I€ Pitef . 4$ ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR AD RES of well/septic <br /> (City,state,Zip) (9i '.State,z ) , ❑Setbacks <br /> PH pH NE ❑Site Plan approval from <br /> Q -6��'D b O� `l — g3.5. <br /> 'S 3 applicable township. <br /> E-MAIL ADDRESS A t , �/ E-MAIL ADDRESS <br /> O t 1.__I L , J i+-t►i/ r� ,/i ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> ❑PARCEL <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG <br /> j <br /> frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT: <br /> P Ci44i C!L- '/.: 14%: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> �I® iq y .c/ EQS� ❑Sanitary permits <br /> C M: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> - ❑ Zoning District <br /> . PI This 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 /> FIEVVERN / EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: ,�►f�r FL/9;t: ❑ ErosionControl permit <br /> /�/ ' i' '7.f j TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: I''3RD FLOOR: <br /> / Ki <br /> filling/access) <br /> Z I -76 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: // and available options. <br /> (Please round to nearest dollar) -41. -4. --0. $ A 6Z)G <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes QNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [3fes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'es 'lo <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) [f res ClIslo ['Don't know <br /> 7. Is this to correct a violation? ['Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -P <br /> 545-112(4/08) <br />