Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAM <br /> i a-1/off'- �"`� /o N Wing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> G3 7 y Oh/er /Zd Delcire 9-i wi ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> R A -- -c-D,19d -f. ' I or cur+H.D',iv c .co 0,1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ 'dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SO /9/k /te 4Lt/ ttAint✓wi t ❑ ite P n including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f II/septic <br /> 6 3"79 12-ivy ,Z' <br /> (City,State,Zip) (City,State,Zip) Setbacks /' <br /> be th e47%c,+ s-3s-3a <br /> PHONE PHONE _ ❑ ite Plan pproval from <br /> GO 6 - as S - a-l61?- lic le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> t.-, ki-ctii44,9/;„c •Co irn loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of prope y <br /> ❑PARCEL NUMBER 04Gc/ -UI/ - .63cv-4 144. r frontage draw o scale. <br /> TOWNSHIP: SECTION: <br /> G✓eyrt,�-4- 0 / '/4: !!/t '/<'/4: jf/C ❑ Drivew permits <br /> ADDRESS: (stat , co " ,town) <br /> G3 87 /2,iver i2"( ❑Sani ..ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT i •IIC, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> S c ae LI [ 90 .7C C 31 Zoning District <br /> . Is project is a new building or structure. <br /> Permute• ise' <br /> ❑This project is an additio /alteration to an existing building or structure. ' <br /> SANITARY SERVICE: PERMIT NUMBER: � ❑ Rural . •dre <br /> FIEWER EPTIC ° V ( .7k (ne existi <br /> HEIGHT INNFTII((i -, NUMBER OF STORIES: (Not in uding basement) <br /> -I` h ❑ Wetla :r oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Sho land (asn chment)i <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ Erosio ' •ntrol permit <br /> ; <br /> 4, TOTAL SQUARE FOOTAGE: ,, (S10, -S,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fill g/access) <br /> 6/GO ■ -eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ O and available options. <br /> (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 EIC ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yelo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ 1'es ❑ <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑1'es ENo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if ne) <br /> 6. Is a location survey required? (see reverse) ❑Yes ['Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -i -i <br /> 545-112(4/08) <br />