Laserfiche WebLink
. ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> a Cs G C §-4'! L4-cf2T ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1 5 o Lo I< L- s3 Sc?3 Variance(# <br /> HOME PHONE (42c*� CELL PHONE @:.)$ E-MAIL ADDRESS <br /> 2O -$66f) 2f 7- 182. 6 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> WI/ 1,64Ra ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> ( a as y Ta, <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> rh 4015rD ) L i 5'3 711 <br /> PHONE PHONE ❑ Site Plan approval from <br /> C c!g $ — 3 3 13 applicable township. <br /> E-MAILADDRESS 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 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> IM p �-Z-a '/a: '/a'/a: ❑ Driveway permits <br /> I fl <br /> ADDRESS: (state,county,town) <br /> S '( O >�—�1 �"460.+ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 106-(16 A-0 Q tT i 0 N ❑ 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: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/FloodOein/ <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: <br /> Li Erosion I:(3ermit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3-S y 41 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -0. -0. ♦ ♦ o and available options. <br /> (Please round to nearest dollar) <br /> `75 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gNo Li Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ei No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? BYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 4alNo <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 Ea No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes a No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ♦ -+ -0 <br />