Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE .NAME A 1 07 es AG 7 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /i5.?5'." 6e-e-e r,'/ RID 56w. 4 fioni wr- .S_3- 81 Variance(# ) <br /> HOME PHONE i CELL PHONE -MAIL ADDRESS <br /> 69$Co31 (,'!4 Site Plan drawn to scale ' <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions , C` <br /> AGENT NAME CONTRACTOR NAME �n <br /> Site Plan including location ' w-r <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic 3 O . <br /> (City,State,Zip) (City,State,Zip) VSetbacks 6 3 " 0 (0 <br /> PHONE PHONE Site Plan approval from <br /> applicable township. At- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale n <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) t <br /> PARENT /PARCEL NUMBER: �{�1 ` CURRENT ZONING: ACREAGE: F1 Elevation of property <br /> ❑NUMBER a)0'_3y1 rV V©Z-C A - / E* 2 1, 0 frontage drawn to scal . <br /> TOWNSHIP: SECTION �- <br /> Vu NAl ) 7 1/4: /1 kJ %A: A/L.7 Driveway permit <br /> ��i <br /> ADDRESS: (state, county 0 <br /> A10?-5- <br /> f- /'GC-1V RD Seriieffitd/]/ k4 5-35 g9 (Sanitary peril its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, . <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PRO '.I SCRIPTION p / / <br /> 4 C t ,-e S ii-4-o' ?V X �o ,( 2 1 •°� Zoning District ,4 1 <br /> • /C his project is a ,--w din. :r structure. Permitted Use? P1,,,,4 cy ` <br /> This project is an a.•ition/alteration to an existing building or structure. S <br /> SANITARY SERVICE: PERMIT NUMBER: 144 Rural Ado -- <br /> EWER [)EPTIC (new/''"" <br /> HEIGHT IN FEET: NUMBER OF STORIES. (Not including basement) • <br /> Wetland/Flaodplain/ <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: OSionControl permit f <br /> 3 2©O 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, r • <br /> filling/access) F2 i <br /> 2ND FLOOR: 3RD FLOOR: ,L^ D D <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: _o ♦ _o ...• ...• $ ty 006100 and available options. 4, <br /> (Please round to nearest dollar) <br /> r <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? [-Yes ❑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 ❑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) ❑Yes ❑No ['Don't know <br /> 7. Is this to correct a violation? Dies ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -0 -0 <br /> 545-112(4/08) <br />