Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER <br /> 0° AMEi4r 4 / �4e j I ' xs, efra04 ❑ Zoning District <br /> OWNER ADDRESS (Number Street,City,Sta ,Zip) "/�� <br /> L/D��' iI A' j 7L,°I L A�Q 4 O ,�'' ❑ Permitted Use? <br /> PHONE E-MAIL ADDRESS <br /> m A�jr. Lf/pI ' M op., /s1B/yrn ei 4.",co" <br /> ❑ Zoning Status;CUP; <br /> AGENT INFORMATION I CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS ❑ Site Plan drawn to scale <br /> and includes dimensions <br /> (City,State,Zip) (City,State,Zip) <br /> ❑ Site Plan including location <br /> PHONE PHONE of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZO G: / 7 • REAGE: <br /> ❑ PARCEL 05i0-;1 t/_i 4 7 �" / +i/p applicable township. <br /> NUMBER /cL / 111 f� <br /> TOW SHIP: / SECTION: CJ Rural Address <br /> �/�L�'�1 d I '/4: '/4'/4: /Gt/ (new/existing) <br /> ADDRESS: ! ���_ <br /> 5GAe 0/6 J Me e Or"e �h 4 5,5.75— ❑ Floor plans to scale <br /> CSM: LOT f SU !VISION BLOCK/LOT <br /> ❑ Elevation of property <br /> PROPOSED PROJECT INFORMATION frontage drawn to scale. <br /> PROJECT /It-7 ON: / <br /> /1 e4e otrf - I^ 4+^A,31p <br /> Li Driveway permits <br /> . 'O,This project is a new building or structure. (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary permits <br /> SANITARY SERVICE: N PERMIT NUMBER: (public,private) <br /> Li SEW SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> / Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FL <br /> 4/ OOR: disturbance, <br /> � ��-7 + TOTAL SQUARE FOOTAGE: 4, (slopes, <br /> / filling/access) <br /> 2ND FLOOR: 3RD FLOOR: —" ‘ <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ Q /��,i')/� and available options. <br /> (Please round to nearest dollar) �P / !f(/ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes $No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project? $Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? A Yes ❑NoZP X 7056.07 <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# "--"*. ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes No <br /> sr76 - o . is - 3 APPLICATION MUST BE SIGNED <br /> r� (Continue on Back) -► ♦ -► <br /> 545-112 tvoat � <br />