Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 3 � / <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM 4 <br /> TICZ sc i otz--ils.s. J t wL 53S-75- Variance(# ) 3� <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS !y�� <br /> `s' am' 5-1 - CSSj 1/41 kk\GO �"I L ` CC(Y) ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Z-1:7A—(p,,- a_cx c X Site Pla " ding laeation ' <br /> AGENT ADDRESS CONTRACTOR ADDRESS ( of w s ptic v <br /> (City,State,Zip) (City,State,Zip) _ Setbacks 3 0/1oPt I-10 <br /> lo PHONE '� \ �� <br /> PHONE PiSite Plan approval from <br /> ht (k' <br /> ��] -- , pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4 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 /> D' DER ak4c601-0.1.6 -6 —1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 05 r5 ' : 5V— '/a'/a: .43 Yt Driveway perm <br /> ADDRESS: (state,county, w ) <br /> 1 i� '�` -� Sanitary p its <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, va ) <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: ) f 5 C— <br /> j . 0,,,,,,,,,,,,,,� T-, ( sz, ,�t x- >4 Zoning District <br /> ❑This project is a new building or structure. A Permitted Use? Peck /5)k <br /> Q This project is an addition/alteration to an existing building or structure. ����`"`'' +v CF/` <br /> SANITARY SERVICE: PERMIT NUMBER: 14 Rural • ••'o . <br /> ❑SEWER 21SEPTIC (new/-i` 'ng <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) / <br /> XWetland/Floodplain/ / (/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> + j <br /> ErosionControl permit d <br /> BASEMENT: 1ST FLOOR: <br /> TOTAL SQUARE FOOTAGE: (slopes,disturbance, VOttfr <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> , <br /> )6 gC /■74 Review Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST: ♦ ♦ ♦ -► ♦ ���! and available options. <br /> (Please round to nearest dollar) U <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Flo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? NYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? L 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 ❑No L Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />