Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / A/ <br /> Zoning/`''1 L1 Zoning Status; CUP; <br /> owNE ADDRESS (Number,Street,Ci ,State,Zip) LLv h,�,,, / 53S Deed Restriction; CSM <br /> 21 F�� Ue� 7dy i' ' / Variance(# ) <br /> HOME PHONE CELL PHONE / E-MAIL ADDRESS <br /> L"Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> S 5?t r j4,,,il4 Lmow cCyi` _.qL# <br /> "7 El Site Plan including location <br /> AGENT ADDRESS CONTRACTO!R ADDRESS of well/septic �"gp <br /> if ifit-c- A <br /> (City,State, / (City,State,Zip) Lid Setbacks <br /> f9% d`% i G✓/ 575-k z NLt2&swi I /Ad *5 ? <br /> PHONE PHONE Site Plan approval from <br /> ket-836-7570 k0 b -271 - $3(o O applicable township. <br /> E-MAIL ADDRESS l_L- E-MAILADDRESS <br /> ,f 5/7 vtic- 5/D/ '' /Tcc/31a.- Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE p p y <br /> ❑ PARCEL o 4-1,A,&/f-3/Z_550-0 �- 1 , 6� frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> �/ey Sse,71 $ ��1yj 31 1/4: NW 1h1h: NE Driveway permits <br /> ADDRESS: / /� " (state,county,town) <br /> 3013 ( L'• <br /> v.' °A ❑ Sanitary permits // <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) /1A9 <br /> tl PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> NOV /1117 is e ❑ Zoning District <br /> . This project 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 /> SEWER/ ❑SEPTIC (new/existing) or <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,,z1./. 2- ❑ Wetiand/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: 1ST FLOOR: <br /> 3 Z60 -3-1-64 y8+ ' + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR:: 3RD FLOOR: f- <br /> filling/access) <br /> /I,7 0 �� r ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ i‘ ,0 i�� 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? CI Yes L/No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes LNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? E Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes C/No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blanlcif none) <br /> 6. Is a location survey required? (see reverse) ❑Yes DI No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes dNo <br /> (� APPLICATION MUST BE SIGNED <br /> c/J 0 (Continue on Back) ♦ ♦ -► <br /> 545-112(4/08) �,1/ J J <br /> A VVV <br /> i1 <br />