Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> f WN t- o` " o a <br /> n Lu z ❑Zoning Status;CUP; <br /> OWNER ADDRESSr((N Number,Street,City,State, Deed Restriction; CSM <br /> (-tia Q l.� P5` , I e_o :41 '.Q t1 u)i 5353(4 Variance(# ) <br /> HOME PHONE / 4`� <br /> CELL PHONE � E-MAIL AD.-ESS <br /> 60s-:CO 1 O' f 11111 ro 1 ` �AOO 1CotY ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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) El 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 PARCEL NUMBER. Q-�f ,� CURB T1Z�NING: ACREAGE n Elevation of property <br /> ❑NUMBER b�(1 `-j3 j�'-_I J CO- • t� , frontage drawn to scale. <br /> TOWNSHIP: SECTION: r / <br /> �)/l��.�J '/4: 5G '/4'/a: ,rY ❑Driveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> z `1ZG, cCA5VO VN <br /> ❑Sanitary permits <br /> CSM: E LOT Z SUBDIVISION BLOCK/LOT <br /> JJJ (public,private) <br /> • <br /> PROPOSED PROJECT INFORMATION STAFF Review <br /> PROJECT DESCRIPTION: �� �c 1i' � <br /> pLo CL �c'! i1IL� ❑ Zoning District <br /> :;This protect is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ /Rural Address <br /> EWER EPTIC .- (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> t o F I ❑ Wetland/ploodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 ErosionContI-OI permit <br /> BASEMENT: 1ST FLOOR: <br /> '?L l.{o 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> Li filling/access) <br /> 2ND FLOOR: 3RD FLOOR: r2 LID <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. <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 5lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ilo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 1:31 ❑I io <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? I es EVo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank• none) <br /> 6. Is a location survey required? (see reverse) EYes o ❑Don't know <br /> 7. Is this to correct a violation? fYes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ -i <br /> 545-112(4/08) <br />