Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER UWE <br /> LOP-1 7- kA SST ._$.Zoning Status;CUP; <br /> OWNER ADDRESS (N ber,�t,city,State,Zip) Deed Restriction;CSM <br /> 3455 f1-.2dI0rn Lgfv Mad,son, 1.11 53713 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60$-2 o-O 0 Co '-ai3-SLig) It Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION <br /> and ind •_ • - .-:.- <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (Ciy,State,Zp) (City,State,Zip) .* Setbacks 3 I /0 4 <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: CURRENT ACREAGE: ❑ Elevation of property <br /> ❑ BER <br /> mos. o7Io-I/4-oC81-5 R a , . 477 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> o7 I I 1/.: SE 1/.1A: NE Driveway perm;,- N k_ <br /> state,county <br /> ADDRESS: <br /> 3455 Fretclory, Lone. Mad'son, (n/i 537!$ ØSanitary . ••.its N A <br /> CSM: LOT Q 7 SUBDIVISION ^ BLOCK/LOT <br /> LoT 1 R.QM (,,. Acres (public cap <br /> PROPOSED PROJECT INFORMATION STAFF REV( <br /> PROJECT DESCRIPTION: <br /> 8'It 10' Add:};on +0 3 'd.€ 4 E-cis+,-; 9 grj a Zoning District <br /> . ❑This project is a new building or structure. Permitted Use? Add`` <br /> kg This project is an addition/alteration to an existing building or structure. 4414- <br /> SANITARY SERVICE: PERMIT NUMBER: Rural �;--- <br /> ❑SEWER '-i4 SEPTIC (mow/:'4 sung 6 A✓ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 01 ,2 4Wetiand/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) /14_ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) AreriosionControl permit �`BASEMENT: 1ST FLOOR: c O d j TOTAL SQUARE FOOTAGE: j Opes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> o filling/access) 1 <br /> — <br /> g 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ -i and available options. A <br /> (Please round to nearest dollar) $ 6 00-S oo <br /> f <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes A No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes A No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes .1a No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (►Mre blank if none) <br /> 6. Is a location survey required? (see reverse) 131104 gNo ❑Don't know <br /> 7. Is this to correct a violation? ❑ii a No <br /> sf G Fx,E, -- 6'35 <br /> APP �M UBT BE SIGNED <br /> (Con <br /> (Con ck) -♦ -♦ <br /> 545-112(4/09) <br />