Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> t�(�\J�� sx��� C �t� ping Status;CUP; <br /> OWNE DDRESS (Number,Street,City,State,Zip) � , S3� Deed Restriction; CSM <br /> \' 11 4-1 1 -1-‘A-NM- ° �` 'P � 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (c,c$.S3S-(2c 38 910 31`i 6b2--) .,r.;c_ exits c i'1 Q \(\t rna,'l• (1'1 ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION 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 ❑Sit pproval from <br /> ap ' a e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> El/4;r plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL d t p,. Y7 1 1, 1 $S30$ <br /> k}i 2 S Cj-7 frontage drawn to scale. <br /> NUM 3 <br /> TOWNSHIP: SECTION: <br /> C '€ G, e e N W 1/4: f\1 E w1/4; riveway permits <br /> ADDRESS: •unty, wn) <br /> - �c- ,�\ S35 -1 <br /> 2_1(00{o� US Kti t�Its C-0 <br /> S itary •ermits <br /> CSM: LOT UBDIVISION BLOCK/LOT � <br /> 28` 1 Z public,p '.. s <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ^ <br /> S oning District <br /> . gThis project is a new building or structure. . Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER ,,f EPTIC i 2.0‘S - �G 7 new"xisting) <br /> HEIGHT IN FEET: ' NUMBER OF STORIES: (Not including basement) <br /> i k Z , S U n G Wetland/Fioodlain/ <br /> Sho -.- attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ra Erosion- <br /> Contr. aermit' <br /> BASEMENT: 1ST FLOOR: 1 <br /> 16:sBC) 2.S 44 <br /> TOTAL SQUARE FOOTAGE: S ®'' ■ urbance, <br /> 2ND FLOOR: 3RD FLOOR: flll`t access) <br /> X/40, KJ/A. 42L <br /> e <br /> view Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -0 -0. -0. -0 -0 -0. $$ K \/1) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Byes ❑No ❑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 UN <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) EYes 171No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes 1No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ - <br /> 545-112(4/08) <br />