Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1� , <br /> �-a�,.�. 1 .'e-t'e r Zoning Status; CUP; <br /> yWNERADDRESS (Number,Street,City,State,Zip) ' Deed Restriction; CSM <br /> 8544 C-'-� r .C�. \S ,C.roSSQIAI."C. WT 53S8 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> . 0i, - . ' -e40 0 • ,-I4 5-1 el 1,0 e.12. ' 410 4•' s. -,i Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Si I n including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w (septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: 4 CURRENT ZONING: ACREAGE: <br /> ❑NUMBER �O0—'] /ON c5-00 6 A- I Y\ 140 _€ frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Bje f r 1�� f O '/4:-S '/41/4: Dr. permits <br /> ADDRESS: county, town) <br /> CSM: vl 9 Co./LOT~ � nl ermits <br /> 14; SUBDIVISION BLOCK/LOT <br /> (P u ivate) NO_Zie\ <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 9/-0/,-.. De I <br /> �-y Ion,I J District <br /> ❑This project is a new building or structure. qPfr miffed Use? <br /> ❑This project is an addition/alteration to an existing building or structure. ." <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> FIEWER r)EPTIC (new <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> a Lt-C4 9') S Wet 'd/F " dplain/ <br /> AREA TO NEAREST SQUARE FOOT:AREA (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) . <br /> BASEMENT: ST FLOOR: ros ,nC.=trol permit" : <br /> I t1 J V j TOTAL SQUARE FOOTAGE: j f� �•/a �d-sSt�u�ba;nce, <br /> 2ND FLOOR: 3RD FLOOR: <br /> resecsvil ii-loc) Revt L`o tionSurvey <br /> ESTIMATED CONSTRUCTION COST: . • <br /> (Please round to nearest dollar) ♦ ♦ ♦ --∎ --∎ -+ $ C/� an le opal s. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes JNo ❑ <br /> ['Yes know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes gNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑No <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) Dies OINo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* —* —0. <br /> 545-112(4/08) <br />