Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / ,I <br /> TO < tr ti �/ ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number, treQteCity,State,Zip) 1� Deed Restriction; CSM <br /> `f( f A 0 �J' l' -e r�'ell kV' 5-3.3 / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6or-Ps'e --t 3 c?q— V G ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 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.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER O ?/! —/Li/—GPY/0 —/ ,> , 12.14-3 // frontage drawn to scale. <br /> TOWNSHIP/:J / SECTION: 3Q'77 <br /> CO gag) C7 Vd fr e (4/-?-// 1/a: 141/x: ❑ Driveway permits <br /> ADDRESS: (/ (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Li (public, permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW "r" <br /> PROJECT DESCRIPTION: <br /> I 00 ('u ra,j P ❑ Zoning District <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: 0.Rural Address <br /> ❑SEWER PEPTIC (Rew/existing) `, It <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) g` a: <br /> l r ❑ wetandFoplain <br /> Shoreland (attachmen <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) - ,. <br /> ❑ ErosionContrvl permits <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: y (Slopes,distur)lance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: oe �-J1^! <br /> LI Review f'•••':ocation Survey <br /> ESTIMATED CONSTRUCTION COST: a 0 afd availabfel.otions <br /> (Please round to nearest dollar) ♦ ♦ "♦ ♦ ♦ ♦ S 00• <br /> `, <br /> 13 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes a No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ag No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? fa Yes ❑No <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? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />