Laserfiche WebLink
. ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PR VIDE <br /> O 1)NER NAME <br /> O/)a ICI <br /> 14 ill bLe r C7 ❑ Zoning us;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> `V) � a estriction; CSM <br /> S7 co_Ca. /;<� 7`7` S /J/Gr v i' C(. 1 ' <br /> C,v I S S�d a lance(# ) <br /> HOME PHONE CELL PHONE /MAIL ADDRESS <br /> 6.0'7 Of: i f 90 ‘o g 573-3.716 hli 6 r4_r 0 At, /. Co.-t.. Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDR SS CONTRACTOR ADDRESS f well/septic <br /> � <br /> (City,State Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ Site Plan royal from <br /> appli a tow ip. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ oo ans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) Elevation of property <br /> D PARCEL PARENT PA EL UMBER:/ C RRENT(�O�I�G: :CREAGE: P P rty <br /> NUMBER ��3r�� � I` (1" 1 S 7 . ? <br /> frontage drawn to scale. <br /> TOWNSHIP: SECT ON /�� ❑ DriveW permits <br /> 14. \ t�4 t/4. Y`r <br /> D C`ti '^`" r,' <br /> ` -f (st ,county,town) <br /> ADDRESS': <br /> `0 X77 Co. Hwy 5 uk /,r`c.."'' 0-' ❑ Sanit. permits <br /> csnuts. LOT I SUBDIVISION BLOCK/LOT (p .lic,private) <br /> PROPOSED PROJECT INFORMATION <br /> ?AFF REVIEW <br /> PROJECT 9ESCRIPTION: <br /> Cp cad i•145 a /)e (-1\-- o?1-/ K • O oning District <br /> ❑This project is a new building or structure. <br /> Permitted Use? <br /> This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' •• = s <br /> ❑SEWER SEPTIC (new -xisting) <br /> HEIGHT IN FEET: (� r NUMBER OF ST?RIES: (Not including basement) <br /> 7 ❑ Wetian•r .•dplain/ <br /> Shor- - • (attach•,-nt) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached arages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion • •i Permit <br /> 4, TOTAL SQUARE FOOTAGE: 4 (slope ±isturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> . 3'<%)(f fitin access) <br /> ❑ Review °cation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and ailable options. <br /> (Please round to nearest dollar) 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? v Yes air'l• ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes L, ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ,❑Y - a-No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ,Yes ❑No <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 l�,J,1 C3 Don't know <br /> 7. Is this to correct a violation? l7 <br /> ❑Yes No <br /> 7 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) on Back) -► -► -► <br />