Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME rr' /� P <br /> c/ L /` /2/JJo, ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City, ate,Zip)) Deed Restriction; CSM <br /> Q ,C-5-O Qol'/ A Variance(# ) <br /> HOME PHONE ELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Q...pf ,r-y h JT Cc�••K - *itiC. (21-44514,n-le /Lo^lJr. - ❑Site Plan including location <br /> AGENT ADDR SS CONTRACTOR ADDRESS of well/septic <br /> idt>c,x /Z P. 0 go ' /1 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> MT-. iV o4' s bl// s-75-7Z. nit i-Are.6 J i.-,./ J3s-7z <br /> PHONE / PHONE / ❑Site Plan approval from <br /> 6' o ( 79 0— .?7-7 V 67 b )__ 7 y F --3 7,y applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS ❑Floor plans to scale <br /> Quti 1•� W�.. r 1'1C .* R;/ 0 v �i _ 4. i <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ON NG: ACREAGE: <br /> ❑PARCEL / _� 3 O f O frontage drawn to scale. <br /> NUMBER oS�y �6 C^7-��/' 75-01-5 <br /> TOWNSHIP: SECTION: <br /> s(Ri.) G- ,- /9 l,, ,?-&-7 1/4: SE 1/a1/a: +E ['Driveway permits <br /> •ADDRESS: (state,county,town) <br /> c S—s o ' 4XZ6 gD /'h T. ji0r"_..F,42 c,,// El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: p <br /> /N,9 00/Z r t10 L 140 p,-7-/t;;s/ ❑ Zoning District <br /> . ❑This 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: kfEPTIC PERMIT NUMBER: ❑ Rural Address <br /> EWER Jr/f 77,r✓ Lam- (new/existing) <br /> HEIGHT IN FE NUMBER OF STORIES: (Not including basement) <br /> 2 O / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ EroslonCOntrol permit <br /> /9 C/ ,l TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: /G� filling/access) <br /> / / t / ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ / U and available options. <br /> (Please round to nearest dollar) $ 1p �C�� U 0, c„ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes [ lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Do ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes Ulo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes alo <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 CelNo ['Don't know <br /> 7. Is this to correct a violation? ['Yes oN0 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />