Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> 011AER NAME r �/ <br /> 1 l^iS N m_ -�t'j�„ and Skei iarlc k .Racer- d6e-r .J Zoning Status; CUP; <br /> OWNER DRESS (Num'er Street, y,State,Zip) M,� <br /> Owl ow icy.1�o�n ST. I ��"'¢V Deed Restriction; CSM <br /> Wti' • 6-3 /2 Variance(# 1c12 GI ) <br /> HOME PHONE CELL PHONE E-MAIL ADD-ESS <br /> • `4". 37.63// hair- 7 A • h4fucktn•a 1DL 1 D ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME (� <br /> N)it N /1-er --Same QS Ahn .❑ Site Plan including location <br /> AGENT ADDRESS CO ACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <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 ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER o6o7Act 8 753(o RN-I 3.3(, frontage drawn to scale. <br /> TOWNSHIP: SECTION: t <br /> SPPIi N�aa 1 t.-' c9 N W 1A: N h>" WA: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 9a l J5 CA W& °OaC t M 4 Hogtb LW 5351 :--- ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 501 X 9'9 1 rjiORIk r 6 1-16d, ❑ Zoning District <br /> . a This 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 /> ❑SEWER 51 SEPTIC 30,557 2_ (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,.... 31 l I ❑ 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 /> N ll / )rj 50 + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> N I l4 - N)pf 4950 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ q5, 000,00 <br /> Zez7 -al3c ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CiiNes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ®Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? II Yes Li No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes la No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# C1Cf c , ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes SifNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 10 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) • —► —► <br /> 545-112(4/08) <br />