Laserfiche WebLink
' <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Fra n J Ace, ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 3 Deed Restriction;CSM <br /> 353 �i'C.h(C, L Ve{-on- W T- 55 358 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> WI" ■ (o -1 g4 Av7-9-0--g53q- I s f ►o ? C)iO(Ee r- lid ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Li Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) CI Elevation of property <br /> PARENT PARCEL NUMBER: _ CURRENTZQNINGi z r ACREAGE: frontage drawn to scale. <br /> ❑ PARCEL 01bt30L}-41�-33 /�/� r/ <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> �O 1/4: s l: 1/,1/4_ ❑ Driveway permits <br /> M i CSI lei 5 (state,county,town) <br /> ADDRESS: <br /> 355�jl- el'ChI C- \2d ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ 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 lrtf 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: „L 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> Z S ♦ filling/access) <br /> 2ND FLOOR:` 3RD FLOOR: 7S-2— <br /> j�►1- 7 Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: �, Si�G J 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 12'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? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes CirNo <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 L 14o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes OAo <br /> APPLICATION MUST BE SIGNED <br /> CI 'Z Z AY, (Continue on Back) ♦ -► <br /> 545-112(4roa) I ( rJ <br /> Z <br /> �b-I ' <br />