Laserfiche WebLink
- ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME _ <br /> U1 Jc.E/i I 11 Elk)tIOL Z Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> • 1343 eTy l`fwy g H, 0 7v/J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 63 I — "8 3.1 — /63 <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 2AIJ R 7(v0.S (Si ,-0(2.-) ?44 J� zcrun0.V S � <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 33/Go Mew 440 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PH /9� <br /> l� <br /> PHONE y21 Site Plan approval from <br /> X33— 66Z(D. applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rSto)Z.e_ 1 d'er*ohr$oNS aH ,3,s Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ;;yy�1 � <br /> PARENT PARCEL NUMBER: CU NT ZONING: ACREAGE: C.. tlevatlon of property <br /> LI NUMBER ER o J4o/O$OQ '293-��+ ) ex _ go, Z. frontage drawn to scale. <br /> TOWNSHIP: SE TION: <br /> SpRtN G( 11-(,.j "Z$ 1/e:5 j '/1/: ,tick) Drivew4 permits <br /> ADDRESS: /��� !j (state,county,town) <br /> CSM: ny SLOT' L � SUBDIVISION BLOCK LOT Sanitafy permits <br /> ---- (public, private) <br /> -PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIO <br /> i2ruovc_ - ,!..a_ ; • D el0/Z K I ( Zoning District <br /> . U This project is a new building or structure. 2,11 Permitted Use? <br /> 4 This project is an addition/alteration to an existing building or structure. yam' <br /> SANITARY SERVICE: PERMIT NUMBER:,- -'CI Rural ess <br /> J SEWER SEPTIC k`�/ i )._, (new/ex'stin <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ('i.), ,.4. Wetl d/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: S reland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ErosionC`ntrol permit <br /> BASEMENT: 1ST FLOOR: \' J, 4, TOTAL SQUARE FOOTAGE: 4, ,,(slopes, turbance, <br /> --- filling/ cess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> —'in Revi 'Location Survey <br /> ESTIMATED CONSTRUCTION COST: -0. -0. ♦ .` a• 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? UYes - No U Don't know <br /> 2. Is there a wetland or floodplain on or near the property? J Yes No U Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? UYes - No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? J Yes Lg.No <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) UYes No L>Don't know <br /> 7. Is this to correct a violation? U Yes •No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -0 —► <br /> 545-112(4/08) <br />