Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O NER NAME <br /> I' O I � 'Rev L'i V, t"- Tc v Sk ❑Zoning Status; CUP; <br /> OWNER AD ESS (Numb r,Stree,City,Sta Zip) , l -I Ci <br /> 66 [I- S 2(bol � J` • )—tctc`J SOS W I 5 l i Variance Restriction; CSM ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME )1�l CONTRACTOR NAME <br /> Acho� ( er))aj �111i( OIntlit ❑Site Plan including location <br /> AGENT DD ESS CONTRACTOR ADDRESS of well/septic <br /> / X10 (3)A�idar1 dr. <br /> (Ci ate, ip) (City,State,Zip) ❑Setbacks <br /> etrj(\SON& ► Ok <br /> PHONE PHONE ❑Site Plan approval from <br /> 60 -(06-5-5-5-6,E-MAIL 608-519-'39 b2 applicable township. <br /> ADDRESS E-MAIL ADDRESS <br /> 0-ilY1 r('(Yloc N . a ' , ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) of property <br /> 1:1 NUMBER <br /> PARCEL NUER: - ^ CURFjENTZONIN ACREAGE:, frontage drawn to scale. <br /> TOWNSHIP: m i le_\ SEC TI N: , 1 Y1 a 1/4.3 w %IA: VV ❑ Driveway permits <br /> ADDRESS: Q t (state, county, town) <br /> 613 �Le�(, qu ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION '';STAFF REVIEW <br /> PROJECT DESCRIPTION. ^ • <br /> Ck �I n ' t ivv i ❑ Zoning Diistrict <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 r)EPTIC (new/exiSting)', <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetla>3d/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: t sT FLOOR: ❑ ErosionCvntrol permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,dt b <br /> sturahce) <br /> fill.inglaccessj <br /> 2ND FLOOR: 3RD FLOOR: x <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: (� and available options, <br /> (Please round to nearest dollar) " 0 ♦ ♦ --► -► --► `J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes N <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blan f one) <br /> 6. Is a location survey required? (see reverse) ['Yes o ❑Don't know <br /> 7. Is this to correct a violation? Elves No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -♦ <br /> 545-112(4/08) <br />