Laserfiche WebLink
, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �-Garst�k�- k.,SC.-v-c �LAC-. 'di ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> k k-755 4)u,,,k crk A. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> OS- (N2 Ct ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME I 1 CONTRACTOR NAME <br /> 5# e4,• Neice,,, _AL tsr:u L-1 ar. Stu tc ..s Lc-c._ CI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS' of well/septic <br /> G 1 $'r&& l a Lo-,nc ‘')-Q.8 1 ter L-av,e <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> s-(e.,,,i Wo, J lU`t I .5-35Sg S- t5n i 1 5-3 r8 1 <br /> PHONE 1/4---1 <br /> PHONE ❑ Site Plan approval from <br /> cog - £373- $/ 65$ 73 e&!t'/ applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <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 /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER sa.`/OS!/-093-z:3Lr6-3. _ <br /> TOWNSHIP: SECTION: <br /> 16.,. \.f.k ct Y4: N‘oli /'/: SW ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> I I7S b v r,k',,,,,-IG Ave- ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION `STAFF REVIIEW <br /> PROJECT DESCRIPTION: <br /> i 4%ov--Vb ex t t5 1 ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑.Permitted Use? <br /> DiThis project is an addition/alteration to an existing building or structure. r-� <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Addres � ` <br /> ❑SEWER SEPTIC 5ab '367 .,(new/exISting) 'i, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) _ �� <br /> . c a ❑ Wetiand/Floodplainf <br /> Shoreland (attachmen :. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErOSiOn4ontrof permit <br /> BASEMENT: 1ST FLOOR: <br /> 2 G, 70 j ,, TOTAL SQUARE FOOTAGE: j (slopess,disturbance, " <br /> !� C filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 16,- -"8/ 15 8 / ° <br /> I r <br /> ❑ Review Location Survey a <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 13 Q QUO c,-t;- and available options . <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? 21.Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No L Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes fa No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 14 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) tElYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? El Yes iZi No <br /> \\1 APPLICATION MUST BE SIGNED <br /> 545-112(4/09) Q (Continue on Back) -► -► <br />