Laserfiche WebLink
(976 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE E 4 a i?CL 4 G 1 i_LC_ ❑ Zoning Status; CUP; <br /> OWNER ADDRESS�(N ber,Street,City,State,Zip T Deed Restriction; CSM <br /> //DO 77 Gv/ [� O CV O✓1 R LC)-!^. ,5-"Ss-9-.? Variance(#__ ____ _) <br /> HOME PHONE CELL PH NE E-MAIL ADDRESS <br /> 3;_t'o 2 6S 5/3 4 2 63— ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> G✓tit -5' 4 1�� , CI Site Plan including location <br /> AGE ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Q. L 71$ <br /> (City,State,Zip) _ (City,State,Zip) CI Setbacks <br /> O',1L� //y c 36e-2 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6 d -SS I — V n®d applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 7‘r 17wtt7 l,;de"5 i /� ,, ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZONI ACREAGE: ,....51.4 12, Li Elevation of property <br /> Li NUMBER 0 5 0 74-51-8/DD —d frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> rf i W1 r s 15 _ '/e:_ /V E ¼¼: ,V E _ CI Driveway permits <br /> A DRESS: 1100 c--r- f (A. <br /> (state,county,town) <br /> CSM: D r �� LOT ' SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> 1 `� (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> P1J ESCRI 4. / <br /> 4k 1 ,4 e J -1''O� "� ❑ Zoning District <br /> . his project is a new building or structure. x`11 ❑ 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) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> X370 , TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: t filling/access) <br /> ,e570 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ coo VD and available options. <br /> (Please round to nearest dollar) 141 tJv . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes gj No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Li Yes (■lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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) ❑Yes 51 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ -► <br /> 545-112(4/08) <br />