Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> all�1('Q 0. 0---)A. oning Status; CUP; <br /> (o/ ER ADDRESS (N mber,Street,City,State,Zip) Deed Restriction; CSM <br /> 3L0 �k 1,6-Y1 Rd ` dOe r c r1 (ft S 3S3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL <br /> r 1;-'?;1-g 3Z ,•;- -8 Z.Z. aura.olsriii e ea. r • . kI2.wc•U` .e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR N,A. E <br /> Key 1,vl o-6-eic ❑Site PI uding location <br /> AGENT ADDRESS CONTRACTOfj,A�uRE-�y d X Of W tIC <br /> y.State,Zip) (City.State,Zip) etbacks <br /> ../(ei <br /> ec-!�r La( .S 3534 <br /> PHONE PHONE ❑Site P royal from <br /> (DOS - 225 - I&SE applica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) E ation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE. p p y <br /> ❑PARCEL `' Q © rontage drawn to scale. <br /> NUMBER os4. C!ON aIa:1 G f ---1 /-� '314 I TOWNS S CTION: <br /> jb 1 '/a: '/a'/a: ❑ Drive y mits <br /> vDD <br /> RESS: <br /> c3L hibI 0 VN <br /> ❑Sanit ermits <br /> CSM: LOT SUBDIVISIO BLOCK/LOT <br /> / (p ivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: _ ' <br /> New z'oo c? c; rra , Rela i��-t'a-n ) From- Every Xjafl District <br /> ❑This project is a new buildig or structure. <br /> LU�ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ty,tifirZldress <br /> rg EWER FIEPTIC (newe hn <br /> HEIGHT IN FAT: _ 11 NUMBER OF S RIE (Not including basement) <br /> H v� ,,,, ❑ Wet - • - ••dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shor • attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: 1----, <br /> Erosio •ntrol permit <br /> 'T_'_°' O A U/�9 + TOTAL SQUARE FOOTAGE: 4 (slope-, • -turbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 'T full�.lacce ,) <br /> yr ( at is [iJ— view Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q -IS X and available tiOns. <br /> (Please round to nearest dollar) --► -► ♦ $ <br /> /1/p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des NINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®1'es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des sigNo <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 ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ■ —► <br /> 545-112(4/08) <br />