Laserfiche WebLink
• <br /> : ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER E g494-116/1/AC l <br /> Df1Q'//, t 8 ❑ Zoning Status;CUP; <br /> OWNER DDRESS (Num.=,Street,City,State, p) <br /> 13,r�7 f e fir6W ,Q , ,005i A -C— Deed Restriction;CSM <br /> HOME P ONE CON E-MAIL G� Variance(# ) <br /> •D�fJf. �! .U��� — O End w � C Pei"iZs5 ,d / Site• Plan drawn to scale /// / <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions II <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zap) (City,State,Zip) X Setbacks Al HONE PHONE 10 Site Plan approval from <br /> applicable township. J' <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ►'i Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: Elevation of property <br /> ❑ PARCEL Q'7/O_ 1 -7-Fao-gl el / �r ' frontage drawn to scale. <br /> NUMBER �[ /L7 +� /-/ �,1 <br /> roWN )P: � �� SECTION:36 y4. /pit) 1 4'/4: SF Driveway pe /� /4 <br /> [/a6 /0 (state,coun /own +r l / <br /> ADESSS: <br /> 3.3J6 ,c,"' ` e f e io 1q� ��/c' /M ' 5��`r� Sanitary permits <br /> CSM: i 1 4.IBDIVISION KLOCK/LOT et4._ <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPT N: <br /> I !A <br /> �c f,V, 1-4 110 Zoning District A ,I irtk <br /> . ❑This project is a new building or structure. ,►' Permitted Use? Ailitiett <br /> This project is an addition/alteration to an existing building or structure. SF <br /> SANITARY SERVICE: PERMIT NUMBER: CRural '.:+"'`- <br /> ❑SEWER XEPTIC (new = ',tin. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> / Wetland/Floodplain/- 4- <br /> AREA TO NEAREST SQUARE FOOT: Oreland (attachmen) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) XErosionControl permit �� <br /> BASEMENT: 1ST FLOOR: ��-t <br /> TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ` <br /> filling/access) <br /> �`S" Review Location Survey k <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q and available options. <br /> (Please round to nearest dollar) $ /j alp e,,©� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 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? tiYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes PiliNo <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 ❑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(4/09) <br />