Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jae /at 6A/4 ❑ Zoning Status. P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D d Re ction; CSM <br /> 90 3 fw 5 ari e(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 7- /WO .4-4 (5.34 Site •Ian drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION an, includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> II •it Ian including location <br /> AGENT AD RESS CONTRACTOR ADDRESS o well/septic <br /> iln -Q <br /> (City,Stat , • (City,State,Zip) Setbacks <br /> PHONE PHONE - ❑ Site Plana al from <br /> appli town <br /> E-MAILADDRESS E-MAILADDRESS <br /> Li F oo ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURB TZ NING: ACREAGE: P P y <br /> ❑ PARCEL ,I 57 p )� frontage drawn to scale. <br /> NUMBER b�/d6 DV- 051-9230-o <br /> TOWNSHIP: SECTION: ❑ Drivew ermits <br /> ")P�. / /..-(_ 0 S 14: /fif 1/414: 5W'' (st ,county,town) <br /> ADDRESS: /r <br /> 9v e S Pt4L A'4 ?^i1 53s'? Z ❑ Sanit- -, permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 0 3 s / (p.- Ic,private) <br /> PROPOSED PROJECT INFORMATION S FF REVIEW <br /> PROJEC DESCRIPTION: �/ <br /> I)eek- l a I� .Sc Z'ningDistrict 3 <br /> • ❑This project is a new building or structure. LI me <br /> ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUf2QBER: ❑ FRura ' a <br /> (/ne <br /> it <br /> ❑SEWER xi SEPTIC 1 exstn /4 <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) <br /> /O / ❑ WetianI4M0 I/ <br /> Shore ' (att:ib rnt " <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosiO ntr0iii <br /> ent< <br /> BASEMENT: 1ST FLOOR: f C n� <br /> 4, TOTAL SQUARE FOOTAGE: ,` (SIO s,disturbance, <br /> fir gfaccess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> S^/72 <br /> ❑ Review Lae n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ --0. ♦ ♦ and ava4 ' ieopttons <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes alNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes el-No Li Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes WNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ErYes ❑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 '4 No ❑Don't know <br /> 7. Is this to correct a violation? p Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -* -+ <br /> 545-112(4/08) <br />