Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ei r 0E- AlAto �m� ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Ems/ At D Sr /�s�bi�i� w Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME/ <br /> c4c,!-71- --A- . -,Pw.4RA0 eel. s(d--1t .I /G. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ro Z ?7Z—.4 '7 U Arf. Zc.D <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> 7,---Aid, 5. .35 7-7 Pz-A-fi-/, wi ,..5"-.3.5 77 <br /> PHONE PHONE ❑ Site Plan approval from <br /> Uv 0 S _Z 3/( 609-Sly Z3/I applicable township. <br /> E-MAILAIDDRESS E-MAIL ADDRESS LI 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 i9/t2— 3Z 3-i/ram/ ---- frontage drawn to scale. <br /> TOWNSHIP: . <br /> 1 ❑ Driveway permits <br /> � �� /a: /a/a: (state,county,town) <br /> ADDRESS: <br /> 10/ 47 O — ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION .,STAFF REVIEW'l <br /> PROJECT DESCRIPTION: <br /> 17 .2_, a-' rim --- 1E0f/oh/de 7' l�.1sr4uc-no.,c &is.r LI Zoning District <br /> . This project is a new building or structure. ?, <br /> ❑ Permitted Use. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑;Rural Address a <br /> ❑SEWER ❑SEPTIC <br /> (new/exiSting)Rr <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r <br /> /Z P�i c EL- crib A74- ❑ WetlandiR od latn/ <br /> AREA TO NEAREST SQUARE FOOT: $horefard (a{tachmen f <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: El ErOS10E Qntrf3jpermit <br /> ��_ �� 1 TOTAL SQUARE FOOTAGE: ` (Slopes,t. isturbance, ,, <br /> filling/access) b <br /> 2ND FLOOR: 3RD FLOOR: <br /> i//fr- '64"--- 4./4"--- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q and available optlOns <br /> -+ ♦ ♦ ♦ <br /> (Please round to nearest dollar) -+ $ <br /> --► i , „ . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EtiYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? aYes LI No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑les ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑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 /> A MUST BE SIGNED <br /> (Continue PPLICATION on Back) —► —► —► <br /> 545-112(4/08) <br />