Laserfiche WebLink
ZONING PERMIT APPLICATION ww.countyofdane.com SUPPLEMENT to Web-App# <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / <br /> OWN RE (Number,Street, �at State, ' ' �I� Zoning Status; CUP; A /Ea( <br /> / Deed Restriction; CSM <br /> ,tea i!D .h �Q � GAT S_�Sw/o Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> f �•_►' :.3 - ; Li .a` z €- aC I ,[,Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION I7�and includes dimensions 1 <br /> AGENT NAME CONTRACTOR NAME <br /> N '% , au Li. A , Sit cluding locatio 1 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of <br /> 4 �Gt,y J Setbacks 6'3/0 , 4d <br /> (City,State,Zip) (City,State,Zip) <br /> & <br /> PHONE Jail initkO, a •■SJ.s /1 PHONE 1_4 approval Plan lana roval from <br /> ( c i 4/32- l36 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> kinoor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �'Elevation of property I <br /> PARENT P•RCE N MBER: CURREN ZONING: ACREAGE: <br /> ❑PARCEL i O / , l .� 3 9 r ? frontage drawn to scale. D <br /> NUMBER // ✓dr ` <br /> TOWNSHI / � SECTtO . s Iv <br /> � C ia1� 3_ DM /` '/a: '/4'/a: FA Driveway perm <br /> ADDRESS: / A/ (state, county, • <br /> 44. /s cl. ki c4,-- ir- ( <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary • u <br /> (public,p, <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT T/tON: Q , x 32 A a d._ ►'„L ,J le Zoning District A - Ex <br /> . <br /> This project is a new building or structure. , /14 , <br /> Permitted Use? � � A <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: kn RuralA <br /> EWER A.--TIC."TIC (new xlStl <br /> HEIGHT IN FEET: / NUMBER OF STORIES/(Not including basement) <br /> /04- <br /> Z Wetland/Floodplain/AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) •' ErosionControl permit <br /> BASEMENT: 1ST FLOOR/ yOD 1 TOTAL SQUARE FOOTAGE: 1 (slopes, disturbance, <br /> I <br /> if <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: / 2 / O M <br /> Y V eview Location Survey <br /> ESTIMATED lease round CONSTRUCTION)COST: ♦ ♦ --0 0 0 $ -0 '00, 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? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ENo <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 ENo DDon't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -+ <br /> 545.112(4/08) <br />