Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NARA <br /> ,e_ i' 1\\r Ur SO n ❑Zoning Status;CUP; <br /> O ER DDR S (Number,Street,City,Stat ,Zip) 1 '' e, - / Deed Restriction; CSM <br /> \S QV V1 `�Q (%Cl� 'C LQY1ovJ U --1 e, <br /> Variance(# ) <br /> HOME PHONE CEL.PHONE E-MAILADDSS <br /> (DC=6 '- (1)3`) ' ' ' cr.t1 '0 _ • .C(3(3 IM❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME TRACTOR NAME ` <br /> AGENT ADDRESS C�RAPC_ ADDRESS Q---0{\5-1(t...CT I Cry Site Plan including location <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> EAA 5 353(4 <br /> PHONE ' ❑Site Plan approval from <br /> I a-9 - '38'5 a applicable township. <br /> E-MAIL ADDRESS E- ESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE <br /> ❑NUMBER (a:Z.40511 -35(4- (Coric-b - \ frontage drawn to scale. <br /> TOWNSH SECTION: <br /> ,( \L■ V 1;� ,/4: wh: ❑Driveway permits <br /> V__ (state,county,town) <br /> ADDRESS: II 1 <br /> 1 \ kcili0 0 ' �\Q d• Edge_✓-� W t 63 3c4 ❑Sanitary permits <br /> CSM: LOT SUBDIVISION ' BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D CRIPTION: <br /> V G, Q ‘€,Li\\C /C) ❑ Zoning District <br /> ❑This project is a new building or st u ture. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: r NUMBER.OF STORIES: (Not including basement) <br /> aG ` ❑ 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 /> BASEMENT: 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review.Location Survey <br /> ESTIMATED CONSTRUCTION COST: r'� and available options. <br /> (Please round to nearest dollar) ♦ ♦ --► "+ ♦ ♦ $ 1�3J (�U(g . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ,f�lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Vo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes fo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes L Ko <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 121No ❑Don't know <br /> 7. Is this to correct a violation? :Yes JIdo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />