Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OW R NAME 1' <br /> IGLJ Ut! JGCt ci' ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zi ) Deed Restriction; CSM <br /> /07/9 Avievidti ` //AAazo/►�1c,nie, �i 535-,() Variance(# ) <br /> HOME PHONE CELL PHOt4E E-MAIL AdDRES <br /> JIB- 3 et 3-L//60 • q in Ck L •046t it 6o.-y, ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> f e itAGV-f ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 20c? �:ioh 55: <br /> (City,State,Zip) (ci ,state,Zip) ❑Setbacks <br /> ,Scia C;� , 1,,%j 535433 <br /> PHONE PHONE ❑Site Plan approval from <br /> 60,6- 39 3- 060S applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL ,r� frontage drawn to scale. <br /> NUMBER (�2f'/0606-053-ehLi-$ R Pi-2 Li. 7�7 <br /> TOWNSHIP: /! SECTION: <br /> '/4: '/4'/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 071 AY11eVIdA gat 44a242/),tt3wj`e` (.J( 53560 ❑Sanitary permits <br /> CSM: LOT / SUBDIVISI6N BLOCK/LOT <br /> /_ ��3 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5O/X 60 r pole 6,i idi,9 ❑ Zoning District <br /> . This project is a new buildiror structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r e� ❑ Wetland/Floodplain/ <br /> 2,S I5 k ie rf- <br /> i Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: 1-1 <br /> ErosionControl permit <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/aCC@SS) <br /> 3 Cz�)) ' I/ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q r� oo and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ CO oo - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes , clo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ❑No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ZYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1No <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 to ['Don't know <br /> 7. Is this to correct a violation? Dyes ADTO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4108) <br />