Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com Ili r) 11=2221:31 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> �14:3 0 .4 ') Pc 1,V c-0 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> hk t . 9 V- tetol ZD .Vt-Aitso tiI WI 532/ / Variance(# ) i <br /> HOME P ONE CELL PHONE E-MAIL ADDRESS ,. <br /> , O• -,(o / ❑ Site Plan drawn to scale t <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions Q K <br /> AGENT NAME CONTRACTOR NAME <br /> ' 1 N a/} 5&{ow E-5- $ Btikl 25- PkSs oC J i-C ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS t of well/septic <br /> /v as6i( okkwboAJ •N D p aac)s 111.0464.) RDI i <br /> City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> '-t0 w 53fl,,O g60 w ( S3960 <br /> P ONE PHONE El Site Plan approval from <br /> AO ) 9-6(39 Co 90 e39-- 6(1 9 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 55 ;k.ta►761,-5 SoC8"(Ml4 1. ,eo.w•- i.,,,_ 1..•.,.. , .o : p,�,� i-, or.-- ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) 111 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER Or]/O• 19345�"d <br /> TOWNSHIP: SECTION: <br /> t�wN c�F {3{.OUW�l.J o Roll F 1/4: '/4'/a: ❑ Driveway permits <br /> (state, county,town) <br /> ADDRESS: Q <br /> L 4,9 L% 6t( RA l 1M f!p t SoN w 1 53 7/ / ❑Sanitary permits <br /> CSM: LOT f SUBDIVISION BLOCK/LOT <br /> (public, private) O <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW c]\ <br /> PROJECT DESCRIPTION: <br /> Tz)e--rtocct.c.9 aAlLiek.6 C Li Zoning District <br /> . <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> OEWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1,4f 1 ❑ 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: I—, ErosionControl permit <br /> 7 1 TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ?9-0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> -01. -0,. ♦ -0. -0.(Please round to nearest dollar) (� MO,DO <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes K.No (Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves R-No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies KNo <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) Elves nNo ❑Don't know <br /> 7. Is this to correct a violation? Elves No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -0 -0 <br /> 545-112(4/08) <br />