Laserfiche WebLink
' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> / <br /> BrL0.YL. �n o u tie_ B0 0 f Zoning Status; CUP; eh....) <br /> OWNER ADDRESS N ber,StreeUCity,State,Zip) Deed Restriction; CSM <br /> �G pt? ow �11 ruLkl rcr (,�l 33S ) Variance(# ) <br /> OME PHONE ..J CELL PHONE E-MAIL ADDRE4S // <br /> 0$ a. -3133 (v0$ aD5--/ • • ^ k 3 4) 'r- z cti-net E. Site Plan drawn to scale / <br /> AGENT INFORMATION I CONTRACTOR INFORMATION -nd includes dimensions i -r <br /> AGENT NAME CONTRACTOR NAME _ <br /> Uarlc I3ui I d erS .1n C . Si - .- •ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS _ - <br /> (city,State,Zip) (City,State,Zip) LI Setbacks 150045/78i <br /> lreidiSOft W1- 370 51 <br /> PHONE P NE / g:ite Plan approval from Alif(6 0g) (/ (,f 3 y ('O pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> i 12 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 4 Elevation of property <br /> ❑ UMBER 0 5 a.10 Sl -30 3-03 4s-I R - / d, S 3 frontage drawn to scale. <br /> TOWNSHIP:u f.l ari d 3 0 SECTION: / t <br /> R '%:_ $"(AI %%: /J Driveway permit I /F- <br /> ADDRESS: {state,county ✓ N <br /> 35 Pac clbu; 1-ar, e , / <br /> CSM: OT SUBDIVISION BLOCK/LOT Sanitary •- �� /�/ <br /> D 5 (publi <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: <br /> l )Ood aleck- (Connech,i art a -fs7 exiS4 Zoning District <br /> 9 9 pi- � <br /> . ❑This project is a new building or structure. SP 611") u-Ppe f d/c/WXto /Permitted Use? Qid,. <br /> Willis project is an addition/alteration to an existing building or structure. d e et- ) / ' S <br /> L'_f <br /> SANITARY SERVICE: ��,, PERMIT NUMBER: Y� Rural ' ••.-- S / <br /> ❑SEWER SEPTIC (n / r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Wetland/Floodplain/ A A_ <br /> AREA TO NEAREST SQUARE FOOT: horeland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t <br /> BASEMENT: 1ST FLOOR: ,) 2 ErOS10nControl permit <br /> s•/J / j TOTAL SQUARE F TAGE: + (slopes,disturbance, ,�(�//� <br /> 2ND FLOOR: 3RD FLOOR:` filling/access) f/V/F+IFJ <br /> C� ! it Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 7p and available options. <br /> (Please round to nearest dollar) 6' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? igiYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes igNo <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 ❑No LI Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) --0. —► -+ <br />