Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME . <br /> Howard Lien & Sons , Inc Caro _yn t', Franklin Lien ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 450 dwj B Cambridge ,lI 53523 <br /> Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 42 –4048 21•–4604 l i e of arm@ m.::.l lb -t e s net ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tom Reece TBD ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 8426 Elderberry Rd <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Madison,WI 53717 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 608-698-8968 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> treece gsacw.com ❑ 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 016/0612-144-9500-7 A-1 260.54 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Christiana '/4: S 1/41/4:R1 2E ❑ Driveway permits <br /> ADDRESS: Z 3 so/ (-{j. k.t — (state,county,town) <br /> approx. X0'6 hosk'Lo`long (fiee address not as.FiEned) ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Proposed 180; comm tower w/ prefab shelter 11 .5x3C O Zoning District <br /> . a 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 <br /> n/a ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ Wetland/Floodplain/ <br /> 10'1 " 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: 3 1 <br /> ❑ ErosionControl permit <br /> ---rJ`r J 5 r 's q IR j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> n/a 3( 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -� -,/ ♦ ♦ -�► ♦ QQ and available options. <br /> (Please round to nearest dollar) $ 18,000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ail No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes l 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 in No <br /> 5. Is this project associated with a rezone/CUP/varjance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Inc 1 in Ds ❑Yes ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes LI No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -* <br /> 545-112(4/08) <br />