Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION' l ' <br /> ' • - ` - CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> /0G r/$ s� 6 ev// 7-44(„? ser'�/�A ❑ Zoning Status; CUP; <br /> OWNER AD RE S,umber,Street,City,State Zip) / Deed Restriction; CSM <br /> f(.9 9' J H� 1 /rte ,`r �yil 535-24 Variance(# ) <br /> HOME PHONE CELL P ON E-MA AD R SS <br /> ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME / <br /> (�#7 - COYS��°4112�J�' ❑ Site Plan including location <br /> AGENT ADDRESS C NTRAC OR ADDRESS of well/septic <br /> (City,State,Zip) (City,SSttaate,ZZiip) Ir ❑ Setbacks <br /> PHONE Pi 7`�14 c a ❑ Site Plan approval from <br /> Z 7?-6-60-6 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> . ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> RR PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> Q FP,AA T L r,�jy� n ^7C� frontage drawn to scale. <br /> NUMBER Nz./05? -i73.07-y K� : 4// <br /> TOWNSHIP: SECTION: <br /> 0 14P /7 ,/: S il ,/4,/: Aic CI Driveway permits <br /> ADDRESS: �" (state, county,town) <br /> yf J i/G 4ny 7 S S7 ( ❑ Sanitary permits <br /> CSM: �� LFT- "' S DIV N BLOCK/LOT <br /> t- (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 4-a-� ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> l 'his project is an addition/alteration to an existing building or structure. , <br /> • <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER IS/SEPTIC (-e# (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I Z it t <br /> AREA TO NEAREST SQUARE FOOT: ❑ Wetland/Floodplainl <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> j� 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> JJ22 �,/Q /�I filling/access) <br /> 2ND FLOOR- 3RD FLOOR: <br /> ' I/1M ` kZ %- ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ and available options. <br /> (Please round to nearest dollar) /'�y/nt' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes L7No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes �❑,NN l 6on't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes LKNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes Q'go <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 1 I oo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes lI1Vo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 1-1,5`U (Continue on Back) —► —► —∎ <br />