Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 'pan A. A' (eIoLa,rck ['Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (s %-: ''$(o`11, 608-3a,540 b■ 4i2'4.® csr,ou'kr'. ., :A- P4 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> R pe Rvps Cvs .,,, F4.�-c..i 4-RA,notra43 LLc El,Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> `)2 L -:ke- Or t-cn•--,11,-, <br /> (City,State,Zip) (City,State,Zip) [,Setbacks <br /> t .osfx: �.,r— , ,.....".7.Z. 53 511 c_ , ,� 63557 <br /> PHONE PHONE ®Site Plan approval from <br /> (901s- atei_d LS (cols-at9-06SI applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> y • men a a.—.—s It `t-(Is . n....-1/4- r •.rc,,ocLs (9T D S • •L4 ®Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL 7-CS C C t 1` frontage drawn to scale. <br /> NUMBER C G/rC A"' .5 <br /> TOWNSHIP: SECT N: <br /> l 1 t r1 c', j-6 LC',__- __ '/4: '//: ❑Driveway permits <br /> ADDRESS: ,{ (state,county,town) <br /> ' 4 /� 1- '� -e �- iSkSanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> q '1 a (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT ESCRIPTION: <br /> ,,J }ia„y,.` ❑ Zoning District <br /> . <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: LI Rural Address <br /> FIEWER REPTIC 13-ac1',- D(7(} 1 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> y`5 a. LI Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> r(� ❑ <br /> ErosionControl permit <br /> BASEMENT: 1ST FLOOR: C1er% TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 2ND FLOOR: 3RD SOOR:� ��<� �f �+ filling/access) <br /> �—' 'UO. . LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ p and available options. <br /> (Please round to nearest dollar) �� t �% % <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes 'lo <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 'lo ['Don't know <br /> 7. Is this to correct a violation? ['Yes Do <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ -+ <br /> 545-112(4/08) <br />