Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 3°\ntnp\WG'rN ems\ ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> --)g 48 Darr`,, R v'-eN-2.A,,G, kf--k S3 S 93 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 605-333 - 764-) 3s. -.0kT.Yi;4EL' c'tvv 4)'co►I.) ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> V 1.) v v- v I <br /> - !<4-) CoV'S 6-v C}"\On ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Li 5.S w <br /> s s ,Vt b Q1d°v. C. Q0A G►, 1 wl S?5 Di <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> (DDS' .3?3.9 j/8 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS c <br /> o yt,`A \,C.('Y1Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevation of property <br /> 0 NUMBER dO).1 �� Q C <br /> ) i8?-v et G k 5 . 1(Z frontage drawn to scale. <br /> TOWNSHIP: , 666 SECTION: <br /> U.e11,.45)( 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: -) 8 4 lfV2^ ^ a` n " n 1 <br /> (state, county,town) <br /> CSM: dLOT f Yt'/`f vSSUUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: DI <br /> X ,(��C.��'., ❑ Zoning District` <br /> . TjThis 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 /> EWER AEPTIC (new/existing) <br /> HEIGHT IN FEET: 1 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: <br /> ❑ ErosionControlpermit <br /> 1 TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: �/ filling/access) <br /> 0O / <br /> / <br /> ❑ Review Location Survey <br /> (Please <br /> ESTIMATED CONSTRUCTION COST: °s and available options. <br /> round to nearest dollar) ♦ ♦ ♦ '♦ <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes RiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes sHNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? IYes N <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? [Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />