Laserfiche WebLink
.ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN4AME <br /> ,, � ❑ Zoning Status; CUP; <br /> OWNER NjADDRESS (Number,Street,City,State,Zip) Deed Restriction C <br /> 1 f 4 R s1/4-1t agcy 9 Crfg't/ t'V l ,5-3 SW- Variance(# &, ) <br /> H• E P ONE CELL PHONE E-MAIL ADDRESS <br /> 14 ;73 ,S ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> id /&S /'VC. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) . I ❑ Setbacks <br /> PHONE P . e Qrh ( , �?�`� ❑ Site Plan approval from <br /> (�,te 767- 272q applicable township. <br /> E-MAILADDRESS E-'1AILADDRESS <br /> cal,,enej's6u.i/dc,will ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Li ElevatlOn of property <br /> ❑ PARCEL -31°�3 pZS /(� �?1R0-Z I,r�I+ _3 i5- & frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> PV-N 33 Y4: NC 1/41/4: N ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1 7710 l�+.t lam!1Al Cg2C 'CCU "/ VI/ S-3 5-7� ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF.REVIEW <br /> PROJECT DESCRIPTIONy <br /> > 40 er+'be.AGcg— ❑ Zoning District <br /> -, This project is a new building or structure. <br /> El Permitted Used_' <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address 3- <br /> ❑SEWER ❑SEPTIC {new/existtng) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r--1 I- 11 ❑ Wetland loodpilalN <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErtS10n -. $ <br /> Z SF 4, TOTAL SQUARE FOOTAGE: j (slopes,t 1Sturb f <br /> filling/acx ess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 z49° S� <br /> ESTIMATED CONSTRUCTION COST: ❑ Review l�cr!catjc�ts`�urvey <br /> (Please round to nearest dollar) '� ♦ ♦ '♦ '♦ 21 ((�® afld aUaltble le-options. <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 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ithes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes lEiNo <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 ' No ❑Don't know <br /> 7. Is this to correct a violation? Lres ilitfvo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -i -► <br /> 545-112(4/08) f,.. , <br /> 1 <br />