Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ,+ - / � r`� �� 1,�� ❑Zoning Status; CUP; <br /> R DD ESS (Number,street,city,state,zi ) Deed Restriction; CSM <br /> W- Le� Ste`87.14,, l/v� - 1� Variance(# ) <br /> H E/HONE.- <br /> / CELL ONE E-MAIL ADDRESS <br /> • <br /> 11 L4. i 0.cti'1 • -o-th- ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT E CONTRACTOR NAME <br /> iI j f i �; f p�ji`S( ��__ ❑Site Plan including location <br /> AG T ADDRE ArldrhAiS CONT ACTOR of well/septic <br /> ??9v -ter ,s,Qe, /2. <br /> (City,State,Zip) (Ciscty,NSit Zip) ❑Setbacks <br /> PHO st4let /'�kL4/wsicysid ❑Site Plan approval from <br /> k 42s 1„7 21 j -r62,7, applicable township. <br /> E-AWARDRESS E-MAIL ADDRESS <br /> d a - pi 4,1, c4i, ❑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 /> ❑PNAURMCBEELP (M2. 0'I L 303-/IT4'-ia A-—1 , 772. frontage drawn to scale. <br /> TOWNSHIP SECTION: <br /> Pre'del o '/a:sE yoh: ,s i ) ❑Driveway permits <br /> ADDRESS: / / (state,county,town) <br /> 3/ �S "€ L P4 I" LQ ❑Sanitary permits <br /> CSM: LOT SUBDIVISION . BLOCK/LOT <br /> (public, private) <br /> I <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /......p. ��,�,/� ..—C y� ,� LI Zoning District <br /> , his 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 /> ETEVVER 14EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> ❑ 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: <br /> ❑ ErosionControl permit <br /> -- — . 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: �_ 3RD FLOOR: __ / � <br /> 1 ❑ Review Location Survey <br /> ESTIMATED ED CONSTRUCTION)COST: ♦ ♦ ♦ ♦ Cfla! n� and available options. <br /> (Please round to nearest dollar) `� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ElNo ❑Don't know <br /> 2. Is there 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 and are they in agreement? ❑Yes ®No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes WNo <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 No ❑Don't know <br /> 7. Is this to correct a violation? Eyes to <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -. <br />