Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME CO 6 6 wPF(7 C . Zoning Status; CUP; 2 <br /> OW ER ADDRESS (Number,lStreet,City,State,Zip <br /> i ggy m I c_c—P D,JQ eS M keetS� IN j S.1 • -t F Deed Variance Restriction; CSM ,3 �� Z <br /> 0 (\ � / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> bog 222-3q227 1'd Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimension V <br /> AGENT NAME CONTRACTOR NAME <br /> x'7/1 Z1 .)& 3 ).5' /A)C Site Plan including locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /22( JE�Ilv/�� Q2 <br /> (City.State.Zip) Cit ,State,Zip) /�1 Setbacks c/.....<7.--c> <br /> •P'5146-S-t./LL,6 w i 5 3 Sys <br /> PHONE PHONE ! igSite Plan ap• --•.. +m <br /> 60g— `{- 6 )3 p applicable : . c; I�'7 <br /> E-MAIL ADDRESS E-MAIL ADDRESS i �. .0 Or ,'SO, <br /> cc ro,-�.,.,a 'fibs- ‘,15•_ c0-,., 1.1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http a/accessdane.co.dane.wi.usl) <br /> PARENT P•' ELL/NUMB `,.CURRENTZONING: ACREAGE: p II Elevation of property <br /> D NUMBER ��I, O/C O—2t t-t lC3- ( Z___ -a , c p frontage drawn to scale. <br /> TOWNSHIP: ,/� SE TIO y� <br /> J ri v 6^ '/e: /VA- '/V: S/� 1=r Driveway permits <br /> ADDRESS: (state,county,, <br /> S- permits <br /> CSM: LOT SUBDIVISION BLOC OT <br /> 1. 1G1- Acs r fi--/o •ub •,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PrIgJECT DESCRIPTION: ■ <br /> Ke—/6-,ag yet 0E-3r(2,/n cQ `�k t( S/i n aye_ (*Zoning District -- L <br /> . OThis project is A new S 1 9 h S it, p e U 3 J ? <br /> ❑This project is an addition/alteration to an existing building or structure. A OK 3 1,4A‹ I/ <br /> SANITARY SERVICE: PERMIT NUMBER: FA Rural '„•( Q n �f <br /> in-EWER f)EPTIC (new!'+/sti • t l l <br /> HEIGHT IN F ET: NUMBER OF STORIES: (Not including basement) <br /> / I Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) A"/4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ACErosionControl permit /7 <br /> j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, i 0 / <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) ��� <br /> Review Location Survey , /I <br /> ESTIMATED CONSTRUCTION COST: <br /> -. -•• ♦ ♦ op and available options. <br /> (Please round to nearest dollar) r b, Opp ■ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes Olo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Wes o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ao <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) QYes 'lo (DDon't know <br /> 7. Is this to correct a violation? IJYes ao <br /> APPLICATION MUST BE SIGNED <br /> 545-112 ta,oat (Continue on Back) -► <br />