Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION ;' CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> l <br /> /n(,/E6 DA4ni V,ti L4+41 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Str et,City,State,Zip) <br /> Deed Restriction; CSM <br /> G CP I b StiA/ t.41' �j Q4-kewAt� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> tIA 23 q _ _ _0''ow, • • n Site Plan drawn to scale <br /> AGENT INFORMATION :. CONTRACT OR_INFORMATION and includes dimensions <br /> AGENT N E CONT CTOR NAME <br /> 77— lista e2L/ -E7u7 `/.9C ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRASS �� of well/septic <br /> 4o n� -� � hue- S) <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> D C-41 ) ( S3S32 ss -E <br /> PHONE l , PHONE ❑ Site Plan approval from <br /> ley— f p�/ V applicable township. <br /> E-MAILADDRES E-MAIL ADDRESS <br /> 4/' . Site-A)PiC• oi ❑ Floor plans to scale <br /> PROPERTY/LOCATION.'INFORMATION,‘,(http:/laccessdene.co.dane wi.us!)_: ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURR TZry�ING: ACREAGE: <br /> ❑PARCEL D$OS ` D2 - 3 f l-G W frontage drawn to scale. <br /> TOWNSHIP: SECTION: A.. TO Nag lib <br /> /J B.F ��nnese- -se '/a: a'/a: Driveway permits <br /> ADDRESS: 4 /Y (state, county,town) <br /> �I�l/�+' ,4(t� Pme-w agau/'t rod El Sanitary permits <br /> CSM: LOT S BDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION <STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> S�41-6 t t poocE O Zoning Distract <br /> [v]This project is a new building or tructure. 0 Permitted Uses <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Q Rural Address <br /> [EWER V EPTIC 113 - 21;115- --0°334 {nevvlexiStlrlg) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> -.2o: I 0 Wetland/Floodpla(1/ <br /> AREA TO NEAREST SQUARE FOOT: Sh orelan d,(att ac h m ent) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: Q EMSPRCO'ntr0 permit <br /> .01i(— • u� 7q 1 TOTAL SQUARE FOOTAGE �S�D es isturbahbe, F, <br /> 3 f (' 7 /� fi f llrngZaccess) , <br /> 2ND FLOOR: 3RD FLOOR: / 4 d <br /> /1A nik ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ■ and available options <br /> (Please round to nearest dollar) 989 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes No ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes flo 20 on't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes ❑N <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) [Yes mlo ❑Don't know <br /> 7. Is this to correct a violation? [Yes EiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -4 —► <br /> 545-112(4/08) <br />