Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME r, <br /> (I (/'j '`- OWCo 0e, -.144 Ur ril ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) /'1 <br /> ,}.). -1 _ 0 e_e,ee' 1/ a-64 ft 5 '3575- <br /> 3 l5 75- Deed Variance Re(triction; CSM ) <br /> Variance # <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> tie O17 5-7 n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRAC OR NAME <br /> `/ I Q�t� n Site Plan including location <br /> AGENT ADDRESS CONT O A REX-L of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> (03D 7- 0-4-4-a?4( , <br /> PHONE PHONE n Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E- AIL ADDRESS <br /> OL L tl • I- A ,P6v1 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danemlus/) <br /> PARENT PARCEL NUMB : i c..4,1`t CURRENT ZONING: ACR AGE: n Elevation of property <br /> ❑PARCEL II �.,' frontage drawn to scale. <br /> NUMBER `�l/-I' C-- / dyl4. <br /> TOWNSHIP: y, z. .-- SECTION: <br /> • <br /> 0(0 1 x12447 'A: WA: n Driveway permits <br /> ADDRE� /��AA pp '' (state, county,town) <br /> a a1 - P C Lit 8-( iti, &&i, 5 El• <br /> Sanitary permits <br /> CSM: LOT SUB BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> l,{' (1 C ,z1 S h i_ iP_a.,11 44 arm 0 Zoning District <br /> This project is a new building or structure. <br /> • ❑ P 1 9 ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: ( NUMBER OF STORIES: (Not including basement) <br /> ( ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA 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 /> y TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> /0 /�'24 Zpa 0- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: _ ♦ —0. —I. --I. —g. <br /> $ <br /> �On 6-- O� and available options.■(Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes MNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies Eb nDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies io <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) ❑Yes ❑No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />