Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 8 g' " _y ->wc . ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 6y.43 NE5g,/i / 1) .I 41A-io6 0n.', 41L S3 ri I ei Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> toy 8'S.3,.3 o LI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGEN NAME CONTRAC OR NAME <br /> /t r:j CD,vST, LL e-- 5. tit Fry t J C /107., Li-c., LI Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> to 1I-x'11 64-6sr 14J /4 34, Ni//a63-T Lit/. <br /> (City,State,Zip) (City,State,',zip) ❑ Setbacks <br /> Ok&Coon/, 1&12 535'7 s 0,f 46onl, IQ z. 5-3 5IS- <br /> PHONE. PH NE LI Site Plan approval from <br /> (04 g 83S gc'7 y (6061 35----178671 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> (/1U!A hone IG uo/, (-M' V4 ca.fjoi',es d 461- est/14" LI 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 frontage drawn to scale. <br /> NUMBER t.00S-I21-/- go72) -9 C- - 6aq/3) <br /> TOWNSHIP: SECTION: <br /> 7r.(,N o f V JfvPr 1/4: 14%. ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: • <br /> 6 i(.3.3 N6 6(1 t P.4 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> D)/z 59-6P1-6E r 5 D `16, X C-(O. Z S y ❑ Zoning District <br /> . This 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 /> ❑SEWER ❑SEPTIC /11/q (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> r2/ i /094 /y 1 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 1----, ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> ,l TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: PO <br /> �J 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -+ ♦ -+ -. �� o 0 O and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes lihslo ❑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? pYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 4Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/varianbe(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No Cl Don't know <br /> 7. Is this to correct a violation? ❑Yes 0 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i —► —► <br /> 545-112(4/08) <br />