Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Reel ♦ Z oceiveN So►rba,c ker ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 655, Al b;or. Load t Etrra✓N WT 53,534 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> •■-77 ., - :lace,yelkay%o a. me.a.co" ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME `' <br /> 6 .GI"r■S enck5krer% HGv4n� c 1-t <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> PO Box 3l1 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> ,CSUA\c• WT 5334 S <br /> PHONE PHONE ❑Site Plan approval from <br /> 0013- 756- Z9 69 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 645 @vnad adva , ci,+one,s- uti ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURREN' NI G: ACREAGE: <br /> 0 PARCEL C. _I frontage drawn to scale. <br /> NUMBER OSIZZ11gSap Q Z.Z? <br /> TOWNSHIP: SECTION <br /> A\bi OA Z1 1/4: E. 'RA: NE ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 6 6 C A--!hie ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DEj�RIPTION: <br /> CCU 4,5 e_ ❑ Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEVVER PEPTIC 13- 2016 - 00111 (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ❑ Wetland/Fk>'odplain/ <br /> (Ai" Z,, ( Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 1--1 ErosionControl:permit <br /> BASEMENT 1ST FLOOR: <br /> Z` Qq Z(8q 1 %1q j TOTAL SQUARE FOOTAGE: 4, (slopes,dtsturbanCe, <br /> 2ND FLOOR: V 3RD FLOOR: <br /> filling/access) <br /> ��0�El S2Si <br /> '� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -• -• ♦ -• -+ ♦ Z�Z,G�• 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? ❑Yes INo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? gYes ❑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#16 e S 7 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) DYes lil o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 N <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i► -+ <br /> 545-112(4/08) <br />