Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER /E 1 <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _ Restriction; CSM <br /> /a6 3 /0 r,, c r,c U 'j/a, /Jcer f c /c) (-J j 52-6 / Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> CON.6 5'S-2 706 ;- 6r 7)dc) ` ` me,' / (O4' -Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C NTRACTOR E <br /> r,'u h ?le, E Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRSS of well/septic <br /> 1 dG 3 j�fc r r.L C�. I l4,e PJ <br /> (City,State,Zip) (City,State,Zip) [' Setbacks <br /> PHONE PHONE Site Plan approval from <br /> ic0,( i S 2 7 06 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) EElevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> EPARCEL frontage drawn to scale. <br /> NUMBER 01(2- 113-14I6O--( i--tom 0_°1 1 4 .4C— <br /> TOWNSHIP: SECTION: <br /> be e r Cr 1 i i 7 1/4: Sw 1/41/4:Sty-) [ Driveway permits <br /> ADDRESS: estate,county,town) <br /> aGg p1,, ,,,, d) 1/, Pc) <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT public,private) <br /> 1L4 5 -2 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: II / <br /> S e J ❑ Zoning District <br /> This project is a new building or structure. Li Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER 1VEPTIC (new/existing) <br /> HEIGHT IN FEET: A / NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1---, ErosionControl permit <br /> ,.Z-o� ,l TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: - v^ <br /> filling/access) <br /> ESTIMATED CONSTRUCTION COST: l/ 1:7 Review Location Survey <br /> (Please round to nearest dollar) "♦ "'.. —ii. —. "'∎ $ �6 dc )� and available options. <br /> i <br /> 4 4O. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ®No SDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes RNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? JYes 711 o <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 Elisio QDon't know <br /> 7. Is this to correct a violation? EIYes Jlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -. -► <br /> 545-112(4/08) <br />