Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> CT'(LAC.. CP0Oe(Z, Arlo Lecc4e E-R-/UISTE, 1\1 ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,StreetJCity,State,Zip) (`��'{' Deed Restriction; CSM <br /> HOMEOPHONE T0‘)NC CELL PHONE I•vU E-MAIL ADDRESS <br /> Variance(# ) <br /> (boa 6013-7S// qs4=) C8"1SI ) LoA+F -'TC,o ' CA4&RT N-14 i fl Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME hAN IE. , 61, Ec, .J<f <br /> 'Rail- TT-tE IJl1-10 ? 6-00up IOC-G ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS II I of well/septic <br /> lad S. DV 1\) cb2, <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Yvi a o IS c'r (An S'S-105 oS <br /> PHONE PHONE I ❑Site Plan approval from <br /> (1)0 Dcl0 9 -0criti applicable township. <br /> E-MAIL ADDRESS -MAIL ADDRESS <br /> i _C ,,, Tt1 F501.136.as es, •.4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑PARCEL D6«Z53 �1o& -3 AI _ (0-Pr-k,Fl frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> ASA►,1T evu AiCr zS v■ 1/o: 5(.v IRA: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 1g0CI TOV eIL Da... ❑ Sanitary permits <br /> CS : LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (1L) E -11 t PAID To -FoJNQPli OA/ 1 1vI>_J:) )\k v\1 Si ■ (,-( Fmk ❑ Zoning District <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 /> TVEWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 311 . 1/ z ❑ 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) <br /> BASEMENT: 1ST FLOOR: „ c�� ❑ ErosionControt permit <br /> S��T --d: I TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> /cc?o �y ♦ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 3 Z--+-7-- <br /> 89 Sa - T 5- c)36°3 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ --► ♦ ♦ $ ---/ow (2oc� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ,lNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes aI o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,JYes •No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ,lo <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) Efres ❑No ❑Don't know <br /> 7. Is this to correct a violation? Elves ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —* <br /> 545-112(4/08) <br />