Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> %t0 i¢m L tedl L G 6 G CI Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> la 902 7�/.-✓ (a/k /I `/Q/6,v Deed Restriction; CSM <br /> HOME PHONE I CELLI�HONE ���MAILADDRES�/ 5 ��� Variance(# ) <br /> ,• - g36- 11.1 . , •lk k- , A d. 'c"/, Co.+- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 4dAems 02.IJ -, 4.,/✓-1.4,siwf ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / of well/septic <br /> /601 4 g.yeig w no/(City,State,Zip) (City,State,Zip) / ❑ Setbacks <br /> /n44d i-sa•✓, ca/ 53 7/3 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6.01-d110-9)6? applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4 C4, p,4)S.K• ,4,44,„50,401,„4„.Can, ❑ 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 /> ® PARCEL �I4 �s frontage drawn to scale. <br /> NUMBER 03$/Cri05-6 S 3-55-°I"0 (--- o! 1 <br /> TOWNSHIP. / // SECTION: <br /> /°V kik 71-0 4/ 3 1//: 5 u) 1//1/4: /j t-✓ ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> j4J Q&,,ec/ Mies; Rvoi/,M/t - s« Q1-1-4ad MAP/4 tteS5 OAae Del. ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Piho,s„td - Sides /3005,E f+ e c/� ❑ Zoning District <br /> . This project is a new building or tructure. G ❑ Permit#ed Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1 ST FLOOR: 0 ErosionCOntrol permit <br /> j TOTAL SQUARE FOOTAGE: , (Slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> (0d ' 0 °- <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ _♦ ♦ ♦ Q v 0 and available options. <br /> (Please round to nearest dollar) d` I O f V D 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L9 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 26o ❑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? ❑Yes 3/No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# —_t ) (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 Llo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ -+ <br /> 545-112(4ro9) <br />