Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 3O 1'1 N d SV1 a .. c W/}LvA C.Z._'-_ Zoning Status; CUP; ✓ <br /> OWNER PpDRESS (Number,Street,City,State,Zip) ,� �/�� Deed Restriction; CSM <br /> `-13 13 c,A-v.! V3P 3a _ MAOI S u N t ~C ' Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS _ <br /> 120-- 257_ -5et 47 SuEL�- /kNNWA{L -Ce 016--/Yv tL Site Plan drawn to scale , - <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> c_ --t-N:: N - S I M t N 0 `S " 1 L � Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic t. <br /> 221 v l - g T l..Ir+ 1-11/J _( z`zI ti-'- [ ►1.in!►z t-1i'Y. <br /> (City,State,Zip) (City,State,Zip) Setbacks I/ <br /> rv}0(SON v41 531t3 MA01.sor\ (,31 53^113 <br /> PHONE PHONE ,Site Plan approval from <br /> (COB. 2ogi L cI B)0 (60 8 2ocj 49 SA, applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> i r,.°iSt IVI6kt\ U U) S -Co NA Jt1'c JS;riot113J►Los _C6 I� 1 ,d Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P rty <br /> ❑NUMBER DSOS-312- -2 No-0 g- t A 1 , 8 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> A�I IQ (5-f-I r-lD 31 '/4: 4 ,4y4: Nvj ,Driveway permits <br /> ADDRESS: (state, county, town) <br /> 5—D ' Sit rt., gLo SS o M GT - 2/Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCIVLOT 2 C i "Tomty Pomp <br /> (public, private) Li <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> N Izv`1 Si N6-L- I A'ti t L 1 H v r( E "zoning District <br /> . ,This project is a new building or structure. ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑;R - Address <br /> EWER AEPTIC 13-2.010—o0018 ` newt= isting). <br /> HEIGHT IN FEET: t i / NUMBER OF STORIES: (Not including basement) <br /> • 3 _ 1 d 2 0 Wetland/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 1 <br /> BASEMENT: 1ST FLOOR: EroStonCorttrol permit <br /> (� Z '�, ` 1 TOTAL SQUARE FOOTAGE: 1 (Slopes,disturbance, <br /> `" 3�O _ �] filling/access) <br /> 2ND FLOOR:I I / 3RD FLOOR: / 5 I <br /> ✓ C7 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: r- and available options.': <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ �JOI Oac�. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ,lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Peso ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ,Oes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yeso <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 Ni o ['Don't know <br /> 7. Is this to correct a violation? Elves /1No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -•1 <br /> 545-112(4/08) <br />