Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com =SUPpL'EMENT#o YYeb App#:: <br /> 'PROP RTY-OWNER:INFORMATION' �_ , , �� .r-,. <br /> ` = 1 CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> StAsah - u-✓oia cl n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Ci ,State,Zip) Deed Restriction; CSM <br /> 3c ct Saddle. Dore,Tirt�11 ,<v v\ �Pr Cure, W 1 5351 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (00$731i ail look-z2c s3 S-ASOLV'. •NIA Mil\k '03wIn <br /> Site Plan drawn to scale <br /> AGENT11NFORMATION _-. CONTRACTOR INFCRMATION .t,*g _� and includes dimensions <br /> 'AGENT NAME CONTRACTOR NAME <br /> . ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,ZZp) (City,State,Zip) n Setbacks • <br /> PHONE PHONE ❑Site Plan approval from <br /> - applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS • <br /> El Floor plans to scale <br /> PROP. RTY/L'OCATION'INFORMAT_ION tt•.//- - - ` <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE . ❑Elevation of property <br /> 0NUMBER O I I-303-0341-6 At- 1 _ 9 q3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> //4_ n Driveway permits <br /> ADDRESS: �- 1 v i-to (state,county,town) <br /> c9 0 Sadd lA 1 .1/0 1 .1/0 0*_Q.. `r ` ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ° L= } `SYAFP IZe-V1EW r r <br /> PROJECT DESCRIPTION: v -4-;z ,Y y e G <br /> CYilG(Ue— coop C S/ /o ) } tZonmg{tDlstnct �� J ' <br /> `t='..1PA:tA'�-a 1 `1i t yf$� elit' <br /> f FSa G b' -..�,r Y k. <br /> This project is a new building or structure. a Pertrlttted Use? I <br /> ['This project is an addition/alteration to an existing building or structure. - `er n'- "- <br /> SANITARY SERVICE PERMIT NUMBER '.`t=1 RiPalfAddress; t;. <br /> EEwER [EPTIC ,i".cnewlextsting) t�- .r=;= - <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including asement) _" '' 1:1.*O .' '!'''''°" <br /> e `� Wetla .d/Floodpialhi. ` - <br /> - �A� k5+ 7 I :fit allSiand'iftacliFnIN <br /> AREA TO NEAREST SQUARE FOOT ��`'�;�r�.�.,-��0^:r�;��,,.y�. _,. <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) , -45"Y i -1% <br /> `❑ EroslonControl-permit <br /> BASEMENT: 1ST FLOOR: - ,� -, - �P' r' '35" <br /> Sc 4,TOTAL SQUARE FOOTAGE: j 3�`--- kslopes;-�ISturbance <br /> 3RD FLOOR 4ifilliiWate l -� "•2ND FLOOR: 3 ---"j` TAO.==aa a- a4 `'t,.. <br /> R e ifikatlbnTSGrvey) <br /> ESTIMATED CONSTRUCTION COST: <br /> I aava � o ot -e* <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ QQ n ,i ; <br /> , ,.. ,, -b� « t s,, <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes igNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes NI o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes U1 o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? - , Yes ['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) Dyes i E o ['Don't know <br /> 7. Is this to correct a violation?- ['Yes 0 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► -+ <br /> 545-112(4/D8) . <br /> • <br />