Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME > �_ <br /> SCO�„Ter/ w�=k e77- 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 2'/6/ /U c,-J'e ,i,t r/2 STOu Gr a 53 Deed Restriction;CSM <br /> y l � Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 5/l/ 3.2. ['Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> O Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ['Setbacks <br /> PHONE PHONE 0 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> O Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: _ _ CURRENT ZONING: ACREAGE: J Elevation of property <br /> ['PARCEL r frontage drawn to scale. <br /> NUMBER 1' gj�—( �e <br /> TOWNSHIP: O6O f f.I_( t f /OQ SECTI9114 <br /> P/e -k, 5 fr, S 1/: 1/1/: 0 Driveway permits <br /> ADDRESS: c✓ (state,county,town) <br /> z±(6 1 i©(A)-(,r 6 ,- <br /> 'CSM: LOT SUBDIVISION 'BLOCK/LOT ❑Sanitary permits <br /> 9/ v (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> a. ,..✓'r: , di T c:.rL 0 Zoning D t <br /> . OThis project is a new building or structure. <br /> Q Permitted Use? <br /> EiThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address EWEREPTIC �_ <br /> (new/existing) <br /> HEIGHT IN FEET ( NUMBER OF STORIES: (Not including basement) <br /> 11 0A/E D Wet an ioodplain/ <br /> bland adltttent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 0 l�.fQSUNTiCrOntrol ermit <br /> BASEMENT: 1ST FLOOR: <br /> 65! 4 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance <br /> 2ND FLOOR' 3RD FLOOR- <br /> ,5"/ "'"T <br /> U Review Location ion Supra <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ QQ�� c9-. end avllt)llbleoptions. <br /> (Please round to nearest dollar) $ 30 ©W <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Oyes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ' lo ['Don't know <br /> 3. Have you talked with the township about your projecand are they in agreement? ['Yes IB o <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 ENo ['Don't know <br /> 7. Is this to correct a violation? ['Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —0. —* -♦ <br />