Laserfiche WebLink
I'7 '' <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> O CUSTOMER TO PROVIDE <br /> OWNER NAME / gyp• <br /> t'o-e_ Ir r� is r ii ❑Zoning Status; CUP; <br /> OWNER DRESS (Number,Street.Cit ,State.Zip) Pii, /�y ? Deed Restriction; CSM <br /> Ltu1i ��{?�il t`% 'lam v"� S�Jvr� Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAI ADDRESS <br /> '- 1�— fit' efQo fdl�— /lJ 0"-/a12 j/ , f/li j j'/f , ' 'Qkc, / Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City.State,Zip) (City.State.Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> 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 �PA�CE//L d X�:� Vl o�v CUR TZO G. ACREAGE: <br /> ❑ Elevation of property <br /> ❑ U frontage drawn to sca <br /> le.NBER a rJ /i, rT <br /> TOWNSHIP: SECTIO :rd rk /: /%:s` v' <br /> ❑ Driveway permits <br /> (state, county, town) <br /> ADDRESS: I I N t (2-60 P u r e❑Sanitary permits <br /> CSM:���� O LOT ' SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D C / <br /> 3 rA PPTION: S GA Illt ❑ Zoning District <br /> . jgrhis project is a new building or structure. ❑ Permitted Use? <br /> This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 119 ❑ R al Address <br /> EWER EPTIC /existing) <br /> HEIGHT IN FEET i NUMBER OF STIES: (Not including basement) <br /> ❑ Wetland/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 /> T: 1ST FLOOR: ❑ ErosionControl permit <br /> BASEMEN <br /> fr Q 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: OJ SO <br /> . ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ cR V and available options. <br /> (Please round to nearest dollar) ) O v <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes giNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ►i' o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? aes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des ONo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#llo J' ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes ❑No ,Don't know <br /> 7. Is this to correct a violation? ❑Yes0No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► <br /> 545-112(4/08) <br />