Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION . CUSTOMER TO PROVIDE <br /> 0 AMEr <br /> cJ5+-o. (, c.._ufS ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> - f4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> .64-75-r-7t 5--- I,4-Gt.U+tic!50DP-601 -% /- co ❑ Site Plan drawn to scale <br /> 'AGENT'INFORMATION CONTRACTOR_INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION.INFORMATION,: (httpa/accessdane,co.dane.wi.us/) : 1_1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER �°Z/or1a-,7Sy-(,as2-`I - 3 <br /> i I-) 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Mb C 1/a: '/a1/4: ❑ Driveway permits <br /> ADDRESS: C (state, county,town) <br /> I O S_-O 0 `�( p ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF:.REVI`EW <br /> PROJECT DESCRIPTION: <br /> C14 Jr (44_,A 6u01 © Zoning Distract r <br /> . UThis project is a new building or structure. .0 Permitted:Use? y <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVI PERMIT NUMBER: =0 RUral AdtdreSS <br /> EPTIC _ (new(eXlsting) <br /> HEIGHT IN FNEWER <br /> NUMBER OF STORIES: (Not including basement) <br /> lG "1 1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Sh$1.:4 d iattachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> ❑ E�oslonContrgt permit <br /> BASEMENT: 1ST FLOOR: y� <br /> j Q j TOTAL SQUARE FOOTAGE. + slopes d sturba(ice, , <br /> 2ND FLOOR: 3RD FLOOR: Y IIlrnglaccess} ` h <br /> • ❑ Review Location Survey; <br /> ESTIMATED CONSTRUCTION COST: $ 306, 00 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? L®Yes ❑No • ❑Don't.know <br /> 2. Is there a wetland or floodplain on or near the property? Yes fNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes EN <br /> 4.'Has there been a zoning permit issued for this property in the past 5 years? Des 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 EiNo ❑Don't know <br /> 7. Is this to correct a violation? DYes EiNo <br /> • APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />