Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER <br /> AdD [/et-INL.. C•/' KM.t./..� ❑Zoning Status;CUP; <br /> OWNER ESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 360 1 Sq j a(4- Ln . Vt4446 oy 1 kir S3?/ 1 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5)5-2g78 dCw .C. 6"as 2 G,tar l•GO ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> ANT NAME . CONTRA(�rOR NAME <br /> 51440.4tifoi�}�'1.► zi�iseve` DestaVV ❑Site Plan including location <br /> A E r CONTRACTOR ADDRESS of well/septic <br /> G iir wtvidse,r Lative, 'IS w/nclsofr" Lager <br /> (City.State.Zip) (City,State,Zip) ❑Setbacks <br /> E PHONE s ✓c//e, W Z S ii‘ a t j t 1 k wt 53S3 El Site Plan approval from <br /> — <br /> q 31 -c72.7 6 0,• 438-622/ applicable township. <br /> E-MAIL ADDRESS Id1 _ E-MAIL •rArt►, a.ume+ .J _,1 ' ',Lc,. , - 4a� rSe _. ' u , I I I,,catip Floorplanstoscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wt.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑NUMBER _OSLO '3o340fQ-q RH ( 3,15" frontage drawn to scale. <br /> TO /SHIP: /� SECTION: <br /> r)V`E Loot 01 W E 'h: 5t41 WA;3d.516 ❑Driveway permits <br /> t (state,county,town) <br /> ADDR ii 6e e 7 g c/+L G+(,v`C>\ ,00 ❑Sanitary permits <br /> CSM: t LOT SUBDIVISION BLOCK/LOT <br /> o yg6.3 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: //'' � ❑ Zoning District <br /> 3 B�eaX Qe am S i AT f a., t'QMN r 1 y reetw. �, I'/ern <br /> . Wiis project is a new building or structure.�`// <br /> ❑ Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER princ n (new/existing) <br /> HEIGHT IN FEET PP`���` NUMBER OF STORIES: (Not including basement) <br /> gD C4- / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionControl permit <br /> BASEMENT ,r 1ST FLOOR: <br /> 1.7 2 $ 3 088 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 1 filling/access)`6 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: @ ��r and available options. <br /> (Please round to nearest dollar) '♦ "I' "� ♦ ♦ $ O O 0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ to EPon't know <br /> 2. Is there a wetland or floodplain on or near the property? [: h! • ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es II a <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes <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 lalo on't know <br /> 7. Is this to correct a violation? [Yes [ f6 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ■ -► <br /> 545-112(aroa) <br />