Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ,,� <br /> /r elerin -r i9haiK-0.- Erenl u.e L-C L�'Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /A / Deed Restriction;CSM <br /> 6-40 �!/'?M-O /e-l• G�Y1L/, wJ 5,35-6-e Variance(# ) <br /> HOME PHONE CELL PHONE _ E-MAILADDRESS _- <br /> Al 1 023-'6119 4 L .10 4 Aoo•c' ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> A1/7- <br /> ////9 ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS offwwell/septic <br /> (City,State,Zip) (City,State,Zip) a Setbacks <br /> PHONE PHONE ite 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/) tion of property <br /> PARENT PARCEL NUMBER: CURRENTZONIIyG:. ACREAGE: eVa p p y <br /> ❑ rNU BER OWN(P1 WOW i 41 -1 y` frontage drawn to scale. <br /> TOWNSHIP://.1 SECTION: �! <br /> (lit h h /Iy '/a: ,/v , %h: � 'krveway permits <br /> ADDRESS: (st e,county,town) <br /> CSM: LOT 3 SUBDIVISION BLOCK/LOT anitary •- t <br /> • (publi•,private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTIONo: <br /> o//6d re Ski 11 Zoning District <br /> . This project is a new building or structure. [ mitted Use? <br /> CI This project is an addition/alteration to an existing buildi per <br /> ng or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: W tvuralA•• -SS <br /> • <br /> /V/9 ❑SEWERPTIC (new -xisting <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement),r1 / <br /> ❑ <br /> miet <br /> 1Ji�etland/Fl odplainl <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) /+ y,,. <br /> BASEMENT: 1ST FLOOR: ❑ EresierC6nlr01permit <br /> /11 to '/ /�l ,, TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> filling/access)FLOOR: 3RD FLOOR: , <br /> Ai /J n /O'xi), 120 <br /> -Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: _p _p _p --► --► _p t // and available options. <br /> (Please round to nearest dollar) 5 4 v Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes I No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 21 No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? KlYes ❑No <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) CI Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes A No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />