|
SUPPLEMENT to Web•Apo#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com
<br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> N t) 1/410‘147 /65K G_S ❑Zoning Status; CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> /079 S A!. / / / /2,6 ,&N E 7)7p u•o1/j49/ S-'(5-/-/ Variance(# )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS
<br /> , 0 S- - - d, A _ , 1, �• • , _ c owl ❑ Site Plan drawn to scale
<br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> 6,114)/ r1/ ,&4eJJ- wC Tiuc 01-1,9G/7/ w4fr onisr;"---;:tic ❑Site Plan including location
<br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic
<br /> r D. ,6° /L e- D `'n /Z
<br /> (City,State,Zip) (City,State,Zip) ['Setbacks
<br /> /4/ .. / ef,,- G, wl S .3S 7 Z r f�°, w/ .-.�s- 7-2_
<br /> PHONE PHONE ❑Site Plan approval from
<br /> (0 0 $, -7 9 S - 3 7 71 &. 0`?,- 79 $-3 77y/ applicable township.
<br /> E-MAILADDRESS E-MAILADDRESS
<br /> 4,4q / _ - -' c cap , /11, ` ,con 2cie►J;t- west c :,- ' i co,,,,, ❑ Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE:
<br /> ❑PARCEL z. O b frontage drawn to scale.
<br /> NUMBER 0 S `j
<br /> 0(p -cis- £ 0 d R H
<br /> TOWNSHIP: SECTION:
<br /> r y S '/a: N w wh: S w El Driveway permits
<br /> -ADDRESS: (state, county, town)
<br /> /0 `" O / N. (V--ay e6 Le/ `I.E." l'') d LA-'"-J63, w/ j7-7"5-7 7 ❑Sanitary permits
<br /> CSM: LOT SUBDIVISION BLOCK/LOT
<br /> 1 (public, private)
<br /> `f 1 z� I
<br /> PROPOSED PROJECT INFORMATION .`STAF°F REVIEW
<br /> PROJECT DESCRIPTION:
<br /> ,S/A)G-A, F41 iii' t/d■74 ❑ Zoning District
<br /> This project is a new building or structure. ❑ Permitted Use?
<br /> This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address
<br /> FIEVVER JEPTIC /�-2 0/6._ O O o 1 (new/existing)
<br /> HEIGHT IN FEET NUMBER OF STORIES: (Not incruding basement)
<br /> Z 5 / ❑ Wetland/Floodplain/.
<br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment)
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches)
<br /> BASEMENT 1ST FLOOR: ❑ E[DSi0rlCQntrol permit
<br /> 7 SJ$ [� Q /�✓G• � JC j TOTAL SQUARE FOOTAGE: 1 (slopes ,disturbance,
<br /> filling/access}
<br /> 2ND FLOOR: 3RD FLOOR: ,, �"i-z:
<br /> Ve l' 8 ❑ Review Location Survey
<br /> ESTIMATED CONSTRUCTION COST: and available opfions, .:
<br /> (Please round to nearest dollar) -0 -0 -0. --0 -0. -0 $ 3 22, 000 . v b
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ❑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) Dyes ONo ❑Don't know
<br /> 7. Is this to correct a violation? [Yes JENo
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue n Back) -► -+
<br /> 545-112(4/08)
<br />
|