Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ijR-114VIN) el Ilzy 711414 i 3 r6 o /0 ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5156, 4o/GE 14/N 10/9-y V edz?f9-, i/ -S3S-93 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 7-d2s753 Nhd3k,q- `" L'7ZS,NAT ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME Q <br /> uie ) C1S'nt p K/4...,tI:k ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 36,0 7Zf'rb ) CA6ss/"la <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> .SU,J it4jg/E, A)/ 6'3596 <br /> PHONE PHONE ❑Site Plan approval from <br /> 83 l-'y? 7J applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Zjs.0 ->✓A) Q Coftem,e,No— ❑ 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 /> ❑PARCEL NI)-0OS-.Va3---y/ O.t) t4 ( 9, W%.9 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> V6gC A)Pt- Y.: '/a'/a: ❑Driveway permits <br /> ADDRESS: ✓ (state,county,town) <br /> /q 18 ft 6-E 1,e;i-1 __ <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> d q �\ (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 1‘)e)-13 511`)&L- i11LY /)9,e_ ❑ Zoning District <br /> OThis project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [ EPTIC /3 -Z-C9 i 0°10 0 3 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> G:21/�/ / .2. ❑ 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 1 ST FLOOR: r--, ErosionControl permit <br /> ,2 <br /> oi G 3Q + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1/g 0 00/O LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ CO 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 [\lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des glo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑c Yes 0VO <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies 'lo <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 ao ❑Don't know <br /> 7. Is this to correct a violation? Elves [.lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ■ —► <br /> 545-112(4/08) <br />