Laserfiche WebLink
11+1165 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN AMEN.. G�_v, v, <br /> \ ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 32-'3'z �'on k-..:) o v t Variance(# ) <br /> HOME PHONE CELL PH E-MAILADDRESS <br /> (9O S X24'13`" 1;1(A— \S 3 ({ c.h (it 23 o Q '►"'�a t I .CC ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME V <br /> ❑Site Plan including location <br /> AGENT ADDRESS CON -'CTOR ADDRESS of well/septic <br /> (City,State,Zi (City,State,Zip ❑Setbacks <br /> PHONE \ PHON• J ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER 6 5 61 -Z52: `$q � frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> y t ws e,`z.V 1/4: %4'/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 004- 61.) A.1 "\ ❑ Zoning District <br /> . <br /> his project is a new building or structure. ❑ Permitted Use <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: , PERMIT NUMBER: LI Rural Address <br /> EWER IC (new/existing) <br /> HEIGHT IN FEE,;: v _ NUMBER OF STORIES: (Not including basement) <br /> �/�'JIrV� <br /> I LI Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensio s including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion Control permit <br /> I_'3- 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR 3RD FLOOR: <br /> 13d -Z <br /> ❑ Review.Location Survey <br /> ESTIMATED CONSTRUCTION COST: �7 and available options. <br /> (Please round to nearest dollar) '♦ -► -0 -0 -0 -0 L O I (5-(110 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes 17 o ❑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'? IgYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EPlo <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 ` lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -► -0 <br /> 545-112(4/08) <br />