Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN E3,' NAME <br /> 44 /�COf S ❑Zoning Status; CUP; <br /> OWNER RES S,_(Number,Street,City,State,Zip) 137/9 Deed Restriction; CSM <br /> 3 OS7 1C�/� St0r7f 4r- of / 9;104 Lr/. Variance(# ) <br /> HOME PHONE CELL HONE E-MAIL ADDRESS <br /> hog-iy' 5 '/ ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO `CTOR N E <br /> uF C6CIIFR /�"/S is/J WiltC7� ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR RESS of well/septic <br /> /08B lie-Ry /e, /eg ///-,f,y /rd <br /> State,Zip (city,� z ) <br /> ❑Setbacks <br /> / , PI 9 � /4 <br /> PHONE PHONE ❑Site Plan approval from <br /> 661-)-SS z/3/ Cji o. — g3 S " 0/ 3/ applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> —5#1./6._ -0%✓¢,A6,1 lAi ,LOS �, Eoc 0,c,t'Act_ ,7 ,, ck, c d w ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0 Elevation of property <br /> ❑PARENT PARCEL NUMBER:NUMBER U Co 7/S/ggpg 59 CURRENT e 'ONING: ACREAGE: <br /> PARCEL /`O J 7 JC'- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> /Og%Al co S,� J 5- %: -J`/' %IA: 124 ❑Driveway permits <br /> A DR s: // /� / (state,county,town) <br /> DR" e 4 inn�t .e ❑Sanitary permits <br /> GSM: 1 S---- LOT A SUBDIVISION BLOCK/LOT <br /> , (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . his 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 /> EWER rPTIC /3—._20/6 -coo 3 Q (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not induding basement) <br /> 1 ❑ Wetland/F000dplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR::' <br /> .2// 8 .2h v s G ,, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> V ✓ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: aLA._ <br /> 6.4f /7y 8 sq •- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ��O �n� and available options. <br /> (Please round to nearest dollar) w <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Etres go ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Pees o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes Rico- <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 Dr< ODon't know <br /> 7. Is this to correct a violation? ❑Yes 91V <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />