Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER AME <br /> &/ essef Zoning Status; CUP; <br /> OWNERA DRES Num er Street,City,State Zip) eed Restriction; CSM <br /> _551anelt�bc in 1 to,_ i Variance(# ) <br /> HOME PHONE CELL P ONE E- AIL DDRESS n` <br /> ,!- -,; /0 el s,- <br /> v d JitZ (• !� ❑ ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT ME CONTRACTOR NAM <br /> lne( Litre 1. i K ite Plan including location <br /> AGENT ADDDSS C NTRA R ADDRES f well/septic <br /> �7 <br /> 641,0q p /O�n cc y C�yC of �l 6T <br /> (City, e,Zi I (City,S take Zi Setbacks <br /> I G • i U ZZ. p1161616.-on a <br /> cS T Z_ <br /> PHONE 5092;z55---3a)e NE ❑Site Plan royal from <br /> applic a town Ip. <br /> E-MAIL ADDRESS E MAILA RESS <br /> Enef 1 • ,d■ ths diel-- ❑ Floor p s to scat <br /> PROPERTY/LOCATION INFORMATION (http://accerariane.co.dane.wi.us/) <br /> ane.co.dane.wi.us/) ❑ Elevatio property <br /> PARENT PARCEL�NUMB NIN ACREAGE: <br /> ❑PARCEL 0 M` _� � � � K. 1,.33 Ac� fronta draw to scale. <br /> NUMBER �WV FFF'�" <br /> TOWNSHIP: SECTI <br /> ''�Ll)y? ( `n kid(1246 J' _ '/: S <br /> %1/4„,s' <br /> /4'/4: ❑ Drivew permits <br /> D RE (stat ,county,t ) <br /> A SS:� 3 w� ‘Dritx 1st Ica El rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT. <br /> t2 6 ; 1. ( ()oaf tot- p (public rivate) <br /> PROPOSED PROJECT INFORMATION h� U STAFF REVIEW <br /> PROJ T D R•TION: <br /> (..„0 ,De LI oning District <br /> . ❑This project is a new building or structure. Permitted Use? <br /> j2fThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural ' °'' "'' <br /> EWER EPTIC (new/= isting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not i cludin basement) <br /> 11 ❑ Wetland/F1 plain/ <br /> Shore! (attach t) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionCOnt permit <br /> BASEMENT: 1ST FLOOR: G,...3 r 4, TOTAL SQUARE FOOTAGE: ,, (slopes, urbance, <br /> 2ND FLOOR: 3RD FLOOR: \`(^J r,� G fIIlling/ ss) , <br /> �" " ❑ Review Location Survey <br /> yESTIMATED CONSTRUCTION COST: ©� (5) <br /> and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ --► ♦ ♦ <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blanl(if one) <br /> 6. Is a location survey required? (see reverse) ['Yes _j, o ❑Don't know <br /> 7. Is this to correct a violation? ['Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />