Laserfiche WebLink
. ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Mici Aria. 1A71-AC kw-t: 4 StA..AE, A. TACt tCK ❑ Zoning Stat ;C[JP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed rlCtion; CSM <br /> 8661 [ VP( NW'( $ SS'oob itu WI 53539 ar ce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4015-51S- 41 1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SNgW 13%- 1011J6÷ D6Sgt 2•(.. -j SAME. ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3icd5 DEFT 93■Nrc ogive <br /> (City,State,Zip) (City,State,Zip) ur Setbacks <br /> 5"roQG4tToiJ WI— S3S$°I /� <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6011- 87'7-1 C 3 1 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • 5 Q 54igi,i6 L42 J Co f,.. Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Cl/Elevation of property <br /> ❑ PARCEL _ Z `tom frontage drawn to scale. <br /> NUMBER 044/0614- 324-055- 3 A -1 f.lk 65 <br /> TOWNSHIP: S TION: <br /> 91-e\SAN SPRiN V_C 1/: S('-■ '/1/: N _ ❑ Driveway fmits <br /> ADDRESS: (state;county,town) <br /> 6-7 COt)t 1 WY 'C3 ❑ Sanita ermlts <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (pupl. , private) <br /> PROPOSED PROJECT INFORMATION / STAFF REVIEW <br /> PROJECT DESCRIPTION: /` `� I_�/ <br /> TAI= Coot--) RGC iLD oEray..14-.0 6ARA66 C 1 ping District <br /> . <br /> This project is a new building or structure. Permitted Use? <br /> ❑This project is an additio alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' ': 'S" <br /> ❑SEWER SEPTIC (new/-xistin. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 14' Ta POO< 1 ❑ Wetland/FI aln/ <br /> h d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ErosionControl permit <br /> G8$ Si t 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> q ! filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 1 ���_1 <br /> ~V11y'� ❑ Review Loc . urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -�► ♦ d+ �o1�O and able 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? .Yes 14o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes Ell() <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes L No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) ((ve blank if none) <br /> 6. is a location survey required? (see reverse) Yes 014o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes UNo <br /> 4 , 14 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ —o. -+ <br /> 545-112(4/08) <br />