Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ( Q <br /> R`t c��j U Gc K S 5 ' ` 0 S el-f-9 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City State,Zip) Deed Restriction;CSM <br /> `� g 85 Feeh S1 rc Ro(, lnoTS- // `'k 5-3s5-- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 S -Z2.$ 'f/2(0 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME p ) 6 <br /> o t p. O.i'I'la I SC LL.Ue r; /moo r 5-c 1-cf.t4 5 -er 0A r ld.e(S 0 Site Plan including location <br /> AGENT ADDRESS /� CONTRACTOR ADDRESS of well/septic <br /> 13 5 ci S LA r v-e vy <br /> (city.State,Zip) (City,State,Zip) 0 Setbacks <br /> 0 etc---)- <br /> (d W � 5�5�1 <br /> PHONE PHONE 0 Site Plan approval from <br /> (,0 g --7 &<(,, 5*o- - l±o 0 ,F _ (o 9. & - -77 2 3 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> J nn o r c t. 110--' r3'► ■;1 ' cow ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE 0 Elevation of property <br /> [PAR 09/Z-3 s/y-1370 -0 A-4 2-) 3 frontage drawn to scale. <br /> TOWNSHIP: r' SECTION: , Driveway permits <br /> Y° `� Y /': w /`/: (state,county,town) <br /> ADDRESS: <br /> ID Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> i Li I tt 3 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF RgyI <br /> PROJECT DESCRIPTION: <br /> Po I c S 4 e 1 D ZDilirlg DIStr <br /> � <br /> . ®This project is a new building or structure. 0 Permitted Use? <br /> [This project is an addition/alteration to an existing building or structure. �r-� <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Andress <br /> EWER 171EPTIC 13 ^ 2,6 ( 1 - (j o o 5-1 (new/.£XIsting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not basement) 0 V1/etland/Floodplain/ <br /> ' MB Shoeland;(attachment)' <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) U ErosionControI <br /> BASEMENT: 1 1ST FLOOR: /I,� ��� <br /> aO ) 5f_3./ j TOTAL SQUARE FOOTAGE , (slopes,disturbance <br /> 2ND'FteiOR '--/ , 3R teoR: ! O�� Si f fillingTecxess7 • <br /> ESTIMATED CONSTRUCTION COST: 0 RBVle11ir1=oC3tiOn aSljrYey-. <br /> -► -► -► -► -► 5-400 r — o and available options <br /> (Please round to nearest dollar) ,..r it <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? [Yes o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [�'(es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EiNo <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 EINio ['Don't know <br /> 7. Is this to correct a violation? [Yes [jlo <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) -► • -► <br />