Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME T <br /> 1J 0.t 1 2 �1• ��a ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction;CSM <br /> HOME E 0 Co CELPHONE ��CE-MAIL� D�E�SS �� t Variance(# ) <br /> • • ' fcc 'n a 6t...a►` . coves ❑ Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> /726:/6 S /Az- ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> ,�,// <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Be-61-4.4 I TW ii` ' v5.�6..- <br /> PHONE PHONE ❑ Site Plan approval from <br /> 6' - 7�"1_ ? 7)5 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> detail Pine. r40 ❑ 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 /> j /� C G Q rpl frontage drawn to scale. <br /> NUMBER o 7V J6 J 3- 1l7)()-- 9 CJ 4 1 Z• i <br /> TOWNSHIP: SECTION: <br /> Vetrrn or t- 0 5 1/4: 01 ,/41/: bL, ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> LI(,2.0 COQCt R 0[0,.d Cc\r4\, Wt 535/c U Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> cket o.c. e r\ (s-p,-rAy e 3c ) `{ 0 ❑ Zoning District <br /> . 'This project is a new building or structure. t ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> J SEWER SEPTIC (new/existing) <br /> HEIGHT IN FEET:/ i_ Z /� NUMBER OF STORIES: (Not including basement) <br /> 7 ❑ 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) <br /> BASEMENT: 1ST FLOOR: ❑ EroSIOnCOntrol permit <br /> /Z 04 ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filing/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ -i ♦ and available options, <br /> (Please round to nearest dollar) /3� 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? yl Yes U No U Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Yes VI No U Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? JYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes N 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 4No ❑Don't know <br /> 7. Is this to correct a violation? U Yes W No <br /> 1 LcC cll ILIO•C° APPLICATION MUST BE SIGNED <br /> (Continue on Back) - <br /> 545-112(4/08) <br />