Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Wob-App 0 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �� � ��� � Ur �-� Zoning Status;CUP; <br /> OWNER AD S (Numbe,street,CityJState,Zip) Deed Restriction; CSM <br /> 978'6 e'gpd;nn/ L.i//e (... a/ii'P, Go/ ,..5-35- 0 Variance(# -Z ) <br /> Ce//-tiecq PHONE CELL PHONE / E-MAIL ADDRESS �,/ R <br /> �i 2/o?"�1/-6 0o '�9 1v2 a f vr, ' -) )7 7/� . - e,7 LV Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME 11/Site 3�e ?S :n/c'i7'r L1YSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS , of well/septic <br /> (City,State,Zip) (City,State,Zip) LT S/etbacks <br /> PHONE PHONE 0 to Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accossdano.co.dano.wl.us/) <br /> PARENT PARCEL gARCELNUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑ NU MBER DSI I-3Aq- (( 5 3 A-3 . 6 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> c- -a jr/'e xi: ., . Driveway permits <br /> (s ate,county,town) <br /> ADDRESS: <br /> (178'"6 'ca'/ Za4e, SUr,-,evp,e 'U/ -5-35 9 O Sanitary permits <br /> CSM: COT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> _S <br /> P REVIEW <br /> PROJECT DESCRIPTION: CQLerP �a� b of l,L I. c1 G �ovrt,7,C"97 /8 3( D' Qele /a-7 ./z,o 7`/2 cL off -40'05C�C?S��e,,,) <br /> Zoning District <br /> ❑This project is a new building or structure. J <br /> 26 his Permitted Use? <br /> U This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Addr r <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: // / NUMBER OF STORIES: (Not including basement) (� <br /> vii b (ji'du,/a'f9 roof) a (6p/4 —/Pw/1)C4/e) -M� VVetland/FI• - •. -4,4 <br /> Shoneland (atta ' nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ljErOSIOnCOt1t1OI permit <br /> BASEMENT: 1ST FLOOR: <br /> 36cD /95-- ,, TOTAL SQUARE FOOTAGE: ,, (slopes,dlstl /� <br /> 2ND FLOOR: 3RD FLOOR: filling access) +t��f/�/- 141 <br /> 9/5- <br /> ESTIMATED CONSTRUCTION COST: and available il ions./Survey <br /> (Please round to nearest dollar) ♦ _ -e∎ $ /90 OOp and available options/v�q <br /> / JJJ <br /> �/ soz.m�r-oil- <br /> 1. <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Ltd No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CI Yes 10 ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1-a.ces GI No <br /> u Y <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ')'Cr✓RCZ j')'/treaf'bI dk if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑Np ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes YNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(a/os) . (Continue on Back) -i -► <br />