Laserfiche WebLink
Z--i 1 o <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Tosep h C. 815 cHoFF C! Zoning Status;CUP; (7 C8G fl" <br /> OWNERADDRES (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> S5' Tay/oat LN S'tc,Agkfoi W( 5,3S el Variance(# Zo1' ) <br /> HOME PHONE CELL PHONE E-MAIL A DRESS y <br /> 97 7- 1 ' 71 c( 909"/ den-TA -4 - 41w ca-6, 'Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AV,f A./I lif Site Plan including location /- <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic ✓ <br /> (City,State,Zip) (City,State,Zip) f I Setbacks ✓/ <br /> PHONE PHONE L Site Plan approval from <br /> applicable township. <br /> (zc -i ct) <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> al Floor plans to scale ✓ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: lif Elevation of property V- <br /> D <br /> PARCEL z r 8 Z , 7...., <br /> frontage drawn to scale. <br /> NUMBER OW0S 11 ZO4. T7ot'O <br /> TOWNSHIP: r t� SECTION: <br /> D V N k (ILs� Z 0 '/,: $6 '/,'/,: 56 4 Driveway permits \ /" <br /> ADDRESS: (state,county,town) �/ <br /> SSC 74 y (O 2 L.N 21 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> / Z d v Z (public,private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> ZN .( 7Z. LF,t3 SEoia'e. qo,,/jt,.n Zo ' gDistrict <br /> . ❑This project is a new building or structure. Permitted Use? <br /> f2This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: I ' e <br /> ❑SEWER %SEPTIC 3 Y c 4 3 8 (new existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ` ❑ Wetland/Floodplain/ <br /> U ` / Shoreland (attachment) <br /> ARLA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ <br /> ErosionControl permit <br /> /7Z_.8 , TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> / 7 Z g eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ "../"" O U t� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ZNo ❑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? IZYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 1'Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 2.01 q ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ZNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes L'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />