Laserfiche WebLink
1 � <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Chr\S ICV�‘p Vie\ ® Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction <br /> 1111 c (ii 1�U1 N . Acs^'s ■,, Ubx- Saco Variance(# tall G'1 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C96cs`S4S-3155 (1nr;S•t( 41 �'-cC14(.(,‘ au., s•GANN & Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> k ss Home --s.Nsfra4try\v-, k ® Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> NVcKS(,„ Kilt 'l(\ , <br /> (City,State,Zip) (City,State,Zip) ® Setbacks <br /> MUD* nh WI (;3`11.1 ct, <br /> PHONE PHONE ❑ Site Ri Droval from <br /> <90%- 44 4rN- "3- --a.:---4. applisable'towrihip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: a Elevation of property <br /> ❑ NUMBER O04 t o(p-ag- -X3730-o 0 i-1.O�-It,�, frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 096 Town\ o �v c IC (c o.r{VN "a i /: N 1 w //: S/W Et Dri eway permits <br /> state,count town <br /> ADDRESS: y, ) <br /> ®• Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 1"4.4(0`1 # I (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NQ).,.) 5 k,.;,j\c ,(,,;c.3,,) R . In,,( C ❑ Zoning District <br /> • ®This project is a new building or structure. ❑ permitted Use? <br /> ��� <br /> ❑This project is an addition/alteration to an existing building or structure. 0 P, <br /> SANITARY SERVICE: PERMIT NUMBER: Rur !Address <br /> ❑SEWER 121 SEPTIC s 1 c6-a3--A, /existing)_Qv-cit.,r <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> ` ��tT <br /> ��t -a ��11 1 ) Vl�gtland Ftorod�tain/ <br /> AREA TO NEAREST SQUARE FOOT <br /> Shore and (attaclment) <br /> T: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> � -\e\ �//lam ��kr\ � ,1, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> LAL13 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -No. and available options. <br /> (Please round to nearest dollar) ``p i OOC) . OC) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ®No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑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 ®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 M,No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► <br />