Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyotdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Dane County Human Service - Lakeview Offices Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 210 MLK Jr Blvd#114 , Madison,WI 53703 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)242-6200 <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ideal Crane Rental, Inc. El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4349 Acker Rd <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Madison,WI 53704 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 241-4092 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ID Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> ❑PARCEL 080925300991 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • 1/41/. 12 Driveway permits <br /> Madison /4. (state,county,town) <br /> ADDRESS: 1202 Northport Dr,Madison, WI <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Setup crane to take down temp cell tower ❑ Zoning District <br /> OThis project is a new building or structure. ❑ Permitted Use? <br /> 12 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 200.0 ❑ 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 /> ❑ ErosionControl permit <br /> 1, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q and available o tions. <br /> (Please round to nearest dollar) $ 20,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q✓Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Q✓Yes EINo <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 ❑IVo Don't know <br /> 7. Is this to correct a violation? [Yes OW <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ –► — <br /> 545-112(4/08) <br />