Laserfiche WebLink
. <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /(>4f// /1)44c'A [Zoning Status;CUP; <br /> OWNER ADDRESS (Number,St ,City,State,LP) Deed Restriction; CSM <br /> 5774 ed u4 6e0)-4) xr /i/ o/v/ / WZ ,S..�3 I Variance(# ) <br /> HOME PHONE CE PHONE E-MAIL ADDRESS <br /> ,D, 1 d- G GOt-5 ,D, dirud <br /> - /I'"721 &Site Plan drawn to scale <br /> AGENT INFORMATION ICONT RACTOR INFORMATION and includes dimensions <br /> AGENT NAME l CONTRACTOR NAME i/ <br /> � , SDI y i .Bd(U ill 010. [[Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS / of well/septic <br /> yfdAf�. t(' 5W- 3 <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> PHONE 7dNeE p,/� [Site Plan approval from <br /> NI 9k-"0/i O`>" -9 �� applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 71401, I . i hlrt,; , , [Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpa/accessdane.co dane.wi.us!) eElevationofproperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> DPARCEL % '7 "' t CA .c1‘00-'7 �7 /�1 /1_ J �2 frontage drawn to scale. <br /> NUMBER T <br /> TOWNSHIP: SECTION: Driveway permits <br /> ���© � ' (state,county,town) <br /> ADDRESS: <br /> 5? /u <br /> ii 4u AO kP Ei5anitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> f;/1 y3D /d k, gal/ii d-yt f 1,s1-,nT- fi 1ti44 M// MI/Zoning District <br /> . This project is a new building or structure. l'P med Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: /Rural Address <br /> FIEWER PTIC (new/existing) <br /> HEIGHT IN FEET: r NUMBER OF STORIE�: (Not including basement) `V <br /> Z ❑ Wetland/Floodplain! 'v <br /> AREA TO NEAREST SQUARE FOOT: Shorelartd (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErOSiOnCOntrol permit <br /> BASEMENT: 1ST FLOOR: '9�� — <br /> I TOTAL SQUARE FOOTAGE: I (slopes,disturbance, A <br /> 2ND FLOOR: 3RD FLOOR: A filling/access) <br /> �� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q and available optionsVQ <br /> (Please round to nearest dollar) $ O/ 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves Do ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [ Yes �o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? �CYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes 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) Dyes [I Io ['Don't know <br /> 7. Is this to correct a violation? Dyes [X Jo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4O8) <br />