Laserfiche WebLink
ZONING PERMIT APPLICATION www.corltyofdane.can SUPPLEMENT to Web-App <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> NAME <br /> Qnie and Ch„ i'"D` ❑ Zoning Status;CUP; <br /> OMER ADDRESS( `'Street, 'See,zP "` Deed Restriction;CSM <br /> j5(.e a 3� I'l , ' ,LI 1 ii-ak 1I 2 ,101 �j'�s 9 0 Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> 3?• l' 40 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> 77 . 0 ( _n 5� CONTRACTOR NAME <br /> V /S El Site Plan including location <br /> AGENT ADDRESS , r CONTRACTOR ADDRESS of well/septic <br /> ( aaa 3srn► .r' ((il C ∎relt, <br /> city, z,P) (City,State,Zp) "❑ Setbacks <br /> �sA 1l) % 535'3 <br /> PFION_ PHONE ❑ Site Plan approval from <br /> (yU • ol L Lt-U.(lei a- applicable township. <br /> E-MAIL ADDffSS E-MAIL ADDRESS <br /> a.thirdokaM. ol) 1 e. e - ❑ Floor plans to scale <br /> PROPERTY LOCATION INFORMATION (http: accessdane.co.dane.wi.us 1 <br /> PAREprr PARCEL NUMBER: CURRENTZONIM ACREAGE: ❑ Elevation of property <br /> 13 PARCEL 01'410$10'6 `.,1 .1.3 .o A 1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 0$ 1 n 0- IA f -s- O 2 '/.: E %%: Si,i ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3 5 l2 z 5 6 J-w y ( I ab-e.l n -Pra rr f., 1x.)1 6 . 5�0 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> L cy. s - (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> l n5 6L11.6-1-101\ o4 16i-QA (',ru Li 0)1 o0- p itr S.qr1 - ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ 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 induding unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: ,ST FLOOR: ❑ ErosionControl permit <br /> X 3 3,TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ip <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ ♦ @ and 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? ❑Yes tgNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ❑Don't know <br /> 3. H a v e you t a l k e d with the township about your p r o j e c t and are they in agreement? , l Yes ❑No <br /> 4. Has there been a zoning permit issued for this property M the past 5 years? ❑Yes Cl 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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes titNo <br /> APPLICATION MUST BE SIGNED <br /> 11211 (Continue on Back) -► -► -► <br />