Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 1 0 U /S d N A ti G Y R A I{ Z D ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> /L7CP Po0LArAI/Z t_ AA/l; ELK GrtovE viL-_ TL_ GQ0° 7 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> /Ll 91 - 3 aLI ; '-/7 ' 9.1 t Gs-3 , - ,71 Q 406 , c 67 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I 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-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usO <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ <br /> NUMBER G j f�3 4 i CS-70 40 ii G S frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> AL 6 /d,� 1/a: 1/41/4: ❑ Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> iS 4 E 1)CN 4 t i e E _)6i_ 270 /1- w / 5--jS- 3Y ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ,L/( G H c w G' 0 <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 20 )( 22 bE. t A c I/ f p G K ❑ Zoning District <br /> JO 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 /> 4 SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland loodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorelartd (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ Erosion Control permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> II Y G ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ It.,,, O ° ° and available options. <br /> (Please round to nearest dollar) $ 20, <br /> 1. The property is within 300 feet of a stream or 10001g9t from a pond or lake? , (es ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the propert ?.,*,,...„ )Z1-Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project ana are4thow in agreement? ❑Yes J4No <br /> 4. Has there been a zoning permit issued for this pr in the past..5 years? ❑Yes JNo <br /> 5. Is this project associated with a rezon�l'GUP/variant j (jl�jtion/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reversei,,.,,, >~/1lx ❑Yes 'No ❑Don't know <br /> J <br /> 7. Is this to correct a violation? ❑Yes P.No <br /> -. <br /> < -," APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />