Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> � <br /> re 0 .4,A.n n �/ Zoning Status;CUP; A .__/./ <br /> OWNER ADDRESS (Number,Street,City,State, ip) � Deed Restriction; CSM <br /> �,?rf1(� S,Or7 Gn / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADD SS / <br /> g97-Ti 27f-3 /-7/ �atif o.�s0',..m,` e ' h/069,(-4,--7 <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> cf9 <br /> AGENT NAME CONTRACTOR NAME �1 <br /> -5-d- Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic / <br /> (City,State,Zip) (City,State,Zip) igj Setbacks 76/0 <br /> PHONE PHONE ,' Site Plan approval from A/ <br /> applicable township. iv <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ill Floor plans to scale /U /1 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �� Elevation of property ./Y'T <br /> 0 PARCEL PARENT PARCE NUMBER:,/ { CURREWT ZONING: ACREAGE: <br /> NUMBER O 1Z-�0511 30/oc�3e Z- 14-1 /,/� frontage drawn to seal . <br /> SECTION: <br /> rrs749/ OW//5.A0 1/4: !tie 1/41/4: 5c 4■I Driveway permit <br /> ADDRESS: J /, (state,count o A • <br /> (9 9V$ 5.e,414,71 �K-At Sanitary p- • its <br /> CSM: LOT Li SaabIVISION BLOCK/LOT u <br /> (p ) <br /> 50o blic,,. <br /> /1-/sh # 4/ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ��D J / I‘ / 4 Zoning District A 'r/ <br /> . <br /> This project is a new building or structure. (P Rc_c ;,permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ,_,t, PERMIT NUMBER: Rural Ad•.:-�s <br /> EWER OEPTIC (new are <br /> HEIGHT IN FEET: YYYY''" NUMBER OF STORIES: (Not including basement) s <br /> /3 / / Vi Wetland/F000dplain/ ,/,v!/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r1 ErosionControl permit <br /> BASEMENT: 0 1ST FLOOR: 3� ♦ TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, f <br /> v 7f.�-� Q filling/access) n-A rip/ <br /> 2ND FLOOR: 0 3RD FLOOR: O s7 / "' �(, / r <br /> y/ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: d ��QQ and available options. <br /> (Please round to nearest dollar) --► ♦ --► ♦ ♦ ♦ $ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes [ No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes g o Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes !1 o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ►;I o <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) fres ENo ['Don't know <br /> 7. Is this to correct a violation? Yes ['No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -+ -► <br /> 545-112(4/08) <br />