Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com ����JJUR alR:.it.>•.��.�_�r.:a <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME i r <br /> 4- 0 a Lei "11`x` `' LA1Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> -7(c /C 19 I %,-,, ■. 7 V Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> as- 33-5 't3 (oaci-c'7?- !6 at., oe V&A Y-'Rs3Ja , %(•c RI Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> El Site Plan includin location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic p- 4p_ <br /> (City,State,Zip) (City,State,Zip) ,{1 Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> fii Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZ NING: ACREAGE: P P rty <br /> 0 PARCEL NUMBER 07og i9�-or57—q /. c frontage drawn to scale. <br /> rl dckkTO H P.[i SECTION: <br /> %: +/%: ❑Driveway permits <br /> ADDRESS: (state,COUn n) <br /> 76 9(0 A I b ve,ro / k9.,r' s 3 c i 3 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> SCW4 i)dl, »T E. k, S Le 2 S'4A{< Pbi YJ ` -fit , 2 7 (public, private) NA <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3 Seasbk,. co,So- a A4-ac1,eci4t 26 3'fiv Fo(11 St,e) ❑ Zoning District <br /> . QThis project is a new building or structure. u0 t,jafi®/ a a i19T <br /> ❑ Permitted Use? <br /> RThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: 'r PERMIT NUMBER: ❑ Rural Address <br /> [EWER [)EPTIC 1v (new/existing) <br /> HEIGHT IN FEET: NUMBER QF STORIES: (Not including basement) <br /> 1 p {e-�.} + ❑ 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 /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> / 7 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> 95 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ —0 and available options. <br /> (Please round to nearest dollar) $ ,24))Od p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des EtNlo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Des o Jon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes LVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ao <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) Ekes DDon't know <br /> 7. Is this to correct a violation? YesVo <br /> APPLICATION MUST BE SIGNED <br /> 5AS119(AA <br /> (Continue on Back) <br /> MI <br />