Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> O NAM�EE <br /> DR 141) ALL-Cr) El Zoning Status; CUP; <br /> OWNER ADDRESS (Numbe Street,City,State,Zip) <br /> Q� O!� ''j` Deed Restriction; CSM <br /> HOME 1 6) Z1Avn CELL PHONY E-MAIL ADDRESS Variance(# ) <br /> o', mG tt,i,ft _.,., I-1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 1QgoVo 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONI G:I ACREAGE: Ej <br /> EI NUM ER Oq 1) -1/2~?Ci(a°-�+ , q A`!( 5-, 9(4 frontage drawn to scale. <br /> TOWNSHIP: I SECTION: <br /> - giz._5-l4_ / / %4: '/4%4: ❑Driveway permits <br /> ADDRESS: _ <br /> (state, county,town) <br /> Z 0 C ( 0- \) ❑Sanitary permits <br /> CSM: ® 7 LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT D SCRIPTION: <br /> beck 4 Poo L- ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER REPTIC (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: r--, <br /> ErosionControl permit <br /> j TOTAL SQUARE FOOTAGE: $, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> So°S1 F� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -- and available options. <br /> (Please round to nearest dollar) ♦ ♦ -I. -+ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes lalo ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes No ElDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? i�Yes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? jYes 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) QYes gNo EDon't know <br /> 7. Is this to correct a violation? Elves .q No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -► <br /> 545-112(4/08) <br />