Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com <br /> !"="2113257 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ''rr 1 <br /> N L. NJe1�ls L (— D Zoning Status; CUP: <br /> ■ Street,City, e.Zip ' ` Yt� Deed Restriction; CSM <br /> Mil 1 _ S-'p�tyl�Con. c/.3.1- 37a( -- — Variance(# ) <br /> OWNERADDRE (Number, 1 <br /> H� <br /> HOME PHONE CELL PHONE E-MAIL''DRESS <br /> - °, 7.614 46. I 4 . .-, j..a. - *(42/tI Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR I:/FORt1ATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> f JD.- c ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> -. <br /> )11-71 �...J .5 — -- _ ID Setbacks <br /> (cny,State,Zip) I � (City,State.Zip) <br /> �a1 1,)1" 53589 <br /> PHONE ...1 PHONE El Site Plan approval from <br /> 1451-.50g-4E00i applicable township. <br /> E-MpIDDRESS 1 � EJMAILADDRESS El plans to scale <br /> •PROPERTY/LOCAT'.ON :N=ORMATION (http://accsssdano.co.dano.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER E CURRENT ZONING ACREAGE, frontage drawn to scale. <br /> ❑PARCEL � StIV <br /> NUMBER b5�o510-'Ot1-tbJl1 �� 1 _ <br /> 'TOWNSHIP: SECTION E Driveway permits <br /> Rw^A — ��___ 1/41/4 (state,county,town) <br /> ADDRESS /4C? OA O , <br /> _ ___ ___. _ El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> S194 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJE D ESCRIPTION <br /> R.R, S+O 1/0;;\ _1_14 <br /> _ _ ]0 x ISO <br /> _ 3 Zoning District <br /> . This project is a new builtling or structure. 3 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER — ❑ Rural Address <br /> EWER DEPTIC (new/existing) <br /> -- ------------- <br /> HEIGHT IN FEET: NUMBER OF STORIES (Not including basement) Wetland/Floodpla- <br /> / 2- - -- - - — Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT. <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> - -- —--- <br /> BASEMENT' 1ST FLOOR disturbance, <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes, <br /> filling/access) <br /> 2ND FLOOR' 3RD FLOOR <br /> 0,0 U Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ d and available options. <br /> (Please round to nearest dollar) $ • 0)QO 0 t 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Vgvo ['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? 1�1 es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? u es Of■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 lalo ❑Don't know <br /> 7. Is this to correct a violation? Oyes Etio <br /> \ t APPLICATION MUST BE SIGNED <br /> t, (Continue on Back) -♦ — –6.545-112/4/081 �i C <br />