Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER s; �/� <br /> A 4 /'A jTG ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 8074 r)U 0 AK T- • Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 408.--2_1° - 4103 SA-Mf- SeAIJM■ ( J€(1/►/),41L,Cr)M ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> -- //AC — /1/4— ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAI L ADDR ESS 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: ❑ Elevation of property <br /> ❑ PARCEL o2o O1t77_o �r,'�� frontage drawn to scale. <br /> NUMBER / 13 - rvozK-2 -� (�•� <br /> TOWNSHIP: (0 7) SECTION: <br /> Li Driveway <br /> V-IY,e. 170,4 t 1.∎)l 5 11177 tv OF O 1 IA: S\14 '/4'/4: S (state,county,town) <br /> ADDRESS: <br /> reQ.74 Nag_ y- TRA1 L. ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> o - i fil l 5— (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> -SZ 122jNi 0 PO(LC N 0Q g. :)u 47p,\ll4 PE LF ❑ Zoning District <br /> . LI This project is a new building or structure. <br /> ❑ Permitted Use? <br /> 14 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1-1 <br /> ErosionControl permit <br /> 2 20 ,, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: J`v filling/access) <br /> 3Z0 .462:0- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -�► -► ♦ v_v_ and available options. <br /> (Please round to nearest dollar) i �0� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes CNo LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes lVo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ' Yes LI No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No ON FILE, <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 tNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - <br /> 545-112(4/08) <br />