Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> DAVE 1 R V /v EIT ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 31 1 1 ,:7-1 y w f MT tioRE 4 t W1• S 3S 1 a-- Variance(# ) <br /> HOME PHONE CELL rHONE E-MAIL ADDRESS <br /> 4..— 3 ,5O-\ ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> FA IIJGnta e0"/Sr. Fi2 I n0Ht3 e-o.,/ sr.. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 30C, &Ty RD I t) <br /> (City,State,Zip) (City,State,Zip) CI Setbacks <br /> ------> JS R/Y U2 IA Wt. s3 col <br /> PHONE PHONE CI Site Plan approval from <br /> 608'_�1 - applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ---- = . , N ' , ! - , 1 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.r.ane.wi.usn <br /> PARENT PARCEL NUMBE : CURRENT ZONING: ACREAGE: LI Elevation of property <br /> ❑ NUMBER OS 060'7 f�-3 7.1. 3 7 frontage drawn to scale. <br /> 1 <br /> TOWNSHIP: YI S 3 9—1 SECTION: <br /> Q <br /> d+ _ Y<: N E 1/41/4: S 4� ❑ Driveway permits <br /> SPRa►AS A.t-(.� (state,county,town) <br /> ADDRESS. <br /> 1( I LTy w/ IN /.1 T• 4,40J4 Wes, sag/) -- ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 'fr ilk 6.9 /c.u*-riL CO a A-, .3 e ❑ Zoning District <br /> . ���❑(((This project is a new building or structure. LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> ANITARY SERVICE: �/ PERMIT NUMBER: CI Rural Address <br /> CI SEWER )(SEPTIC (new/existing) <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) <br /> a- ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> bance, <br /> 4-511)( t r S4/1 f filling/access) <br /> ND FLO OR: 3RD FL OOR: <br /> )-1-(X X r S/'/ <br /> 3/ '3?5 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► C and available options. <br /> (Please round to nearest dollar) 1 13/ �,d <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 o ❑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 ytNo <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) LI Yes XNo Li 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 />