Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN AME _ <br /> cr`.01 CAI (Al I �'u' '}�v ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Nmber,Street,City,State,Zip) Deed Restriction; CSM <br /> of `I 0 U (2(A e.2--r- S T-7/...e e-T ST L-)1,1-6 w t Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> Got_it75- c>6 2— ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> L 4( t:..-v ni/1-rc c tt o a ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> P 3 d l t/e,L.r✓o,.7 1?. . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> S7.7.c.'J 1,-.1—a.,> W? <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6o,S-- 7/7-- 5-64'Z-- applicable township. <br /> E-MAIL ADDRESS 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 0-57109/B3Zso g2- . 94 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIIP: SECTION: <br /> . _ <br /> IA nJ K.t ILK_ o 1/4: 1''ir-+ 1/414: it/E ❑ Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> a 0 7 ? 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> A-pq 3 Sea-$0x1 7n Bch,a QccK ❑ Zoning District <br /> ❑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 /> ❑SEWER tia SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3 Li Wetland/Rooctgain/ <br /> 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: ❑ I»rosionContro-permit <br /> 3 o ate 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturk Once, <br /> 2ND FLOOR: 3RD FLOOR: o <br /> filling/access)LQ- <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST and available options.-1 -0. -0.. -1. -. -0. $ Boca <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 ANo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes O.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 ❑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 'W.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'j.No <br /> r <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) J' 0 (Continue on Back) -► -+ <br />