Laserfiche WebLink
A .1.4- SUPPLEMENT to Web-App # <br /> Y <br /> ZONING PERMIT APPLICATION www.cciuntyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> c enm I� i ul70/ZF ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,Citt,State,Zip) Deed Restriction; CSM <br /> 100 clN/z-i R04-p 0--t )/tl) W 9-39-7C- Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADQRESS <br /> / <br /> (p0 23s--74'05 el? U(PSI 5 ` i real <br /> $) . C0M ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> 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 /> PARENT PARCEL NUMBER: CURRnRENTZONIN ACREAGE: <br /> 1=1 NUMBER D 10 -on---?2.40-- I /1 ` I (Ex) I. 72-et frontage drawn to scale. <br /> TOWNSHIP: / 4 SECTION: <br /> RUT I ND ,/4: ,/4,/4. El Driveway permits <br /> ADDRESS: (state, county,town) <br /> 1190 �iloti,-14g ,LD , oRE ni, WI 975 <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> FR•ar foActt n>w ReflA P,4Tiv f 4 DD/T lo/k) No (00 ' ❑ Zoning District. <br /> . A This project is a new building or s ructure. &m u^ ,c attte Q 01 Permitted Use? <br /> ra his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [)EPTIC (neW/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 1 ❑ Wetland/Floodplan/ <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: ❑ permit <br /> ErosionControl; <br /> X V(O 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: I <br /> '/v ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -0. L and available options. <br /> (Please round to nearest dollar) ♦ -► ♦ ♦ $ r�9- 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes EiNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes pi■o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? plies ill o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres AS No <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? ❑Yeslo <br /> VAM 1W/�� }�� �/ at a,,, ,� er� 4,4 01 <br /> eii �M.( v YJ ibtr5 APPLICATION MUST BE SIGNED lot IN �`� " �� l (Continue on Back) ■ ■ -+ <br /> f Ca"PL <br />