Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> DO c\vw eve ---cD\Ay.,sov\ <br /> OWNER A..RESS (Number,Street,City State,Zip) c, oning Status; CUP; <br /> �,��� CR E- �V �3�-- ( Deed Restriction; CSM <br /> HOME PHONE CELL PHONE Variance(# ) <br /> E- IL ADDRESS <br /> a---2 cr 3 c1 -81te`lan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> e Plan including location <br /> AGENT ADDRESS CONTRACTOR Ae S RESS of well/septic <br /> (City,State,Zip) (City,State,Zip) <br /> acks <br /> PHONE PHONE <br /> ❑Site PI n a royal from <br /> appli a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> O Floor p s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> 0 PARCEL <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevat'.n •-f property <br /> NUMBER _/ R- frontag: a rawn to scale. <br /> TOWNSHIP: (� SECTION: <br /> 0 .),W\ 0 QuvN'-otr V '/4: '/Y4: ❑ Dri :� permits <br /> ADDRESS: (s . e,county,town) <br /> 1 n /I ❑Sani . .ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> q (pub• , e rivate) <br /> PROPOSED PROJECT INFORMATION S AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> CA-;, (NC-Q A CO I 0 x))-- Wing District <br /> • R, <br /> This project is a new building or structure. p <br /> This project is an addition/alteration to an existing building or structure. Et.1 fitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Add - <br /> J)EWER [)EPTIC (n /•."sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ��) per-t etland/ oodplain/ --.�, <br /> AREA TO NEAREST SQUARE FOOT: R"'= -chment) (''n <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Ir rosionControl pe It <br /> TOTAL SQUARE FOOTAGE: + (Slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fillip <br /> ccess) <br /> iOXaO I JOs 0- Ilkihiew Location Survey <br /> ESTIMATED CONSTRUCTION COST: —I. —I. —o. —o• —I. and available options. <br /> (Please round to nearest dollar) $ (1,,,,z, <br /> rt'o1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Dies ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes ONo <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 ONo ODon't know <br /> 7. Is this to correct a violation? Oyes ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -♦ <br />