Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com rY'ljUlt4 t4'`111;111'1445- "I <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> I(e- (Y Gv.,,, Le rov. 6 v-.re.vt Craytd.krSo t' ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> I -3 S3e-v vi 5 1-, CcztM-bn'd u) ( S3 5-13 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (DOV-S 75-5a1-( p0--re . • I)vtitierS6 n0 0.1/06,.Cei^'l ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> --I-7 vI4 660„. 1 ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> A) 14311 Po p(0`r Ale. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Ca-34%16r;ell c, W{ 5 3533 <br /> PHONE PHONE ❑Site Plan approval from <br /> boo$ -ada- (OO applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 004(.1 156)C.-WU- er-./LC f ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG E�: 1=1 Elevation of property <br /> ❑NUMBER D S 1 1 ._ r)-144 -%CO-I kW- 1 5. 11// ' frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> �lJ vt. t`i-14- �)-i ' : 4) k) WA: 3 ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> -I 2- 7 'row£_- _by. <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1 3 9 3 I (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Al t; 6 titA_J2._ ❑ Zoning District <br /> . This project is a new building or structure. ❑ Permitted Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> (EWER KiEPTIC (new/existing) <br /> HEIGHT IN FEET: �ll�Il ```"`"""""" NUMBER OF STORIES: (Not including basement) <br /> a , s -F-d- 1- ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 0,1 5 CA O I 33 1 5 ,5 S.3 j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: � C� <br /> filling/access) <br /> S 1(- 5 1 <br /> Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ _� ♦ „♦ ♦ $ 333,S O and available options. <br /> (Please round to nearest dollar) <br /> 41 I{1" 3Z <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? * es ❑Vo ❑)on't know <br /> 2. Is there a wetland or floodplain on or near the property? 0 es Il o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ►∎ es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? II es ill 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) Ekes rA o DDon't know <br /> 7. Is this to correct a violation? Efres F2 o <br /> APPLICATION MUST BE SIGNED <br /> ^ .MO (Continue on Back) + -► <br />