Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> - t % 1 ❑Zoning Status; CUP; <br /> O ER ADDRESS (Number,Str-- City,State,Zip) J ^ <br /> Deed Restriction; CSM <br /> .1/11. • . ■ elfhl N 4 • ka4r-0_ ►•]a Variance(# ) <br /> HOME PHON CELL PHONE E-MAIL•DDRESS <br /> 1-Q:=7- ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME \ CONTRACTOR NAME <br /> %&..2A4- _ ��o■._ ■�i x IOW .. •. _ , ■ .1. k •`e .r ❑Site PI n including location <br /> AGENT AD DRESS ONTRACTOR •DDRESS of�c <br /> -7a 9NI1I1 c <br /> (Ci State,Zip) ate►,. iv(City,State,Zip) M Setbacks <br /> PHONE C - PHONE Site Plan approval from • ert <br /> v ' — r /Pt. .D,ta. ' \ applicable township. 41 VIA <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> f <br /> ,. A _� _ `� , u� a; ❑Floor plans to scale i (("" <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> PARCEL /� frontage drawn to scal <br /> ❑NUMBER b 110-051-.3,5 Z-S-y tz-' 1 o. (2zi f <br /> • HIP: SECTION: <br /> u• ,I '/4: '/4'/4: Driveway permits 121 leici," <br /> ADDRESS: ,,'^-', , (state,county,town)I.SOLA <br /> CSM: Uv .- LOT �•+'•3 DIVISION BLOCK/LOT\-) IV }1 1XSanitary permits �� <br /> —1 61 pt€z 1X Sanitary <br /> private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REYteW <br /> PROJECT DESCRIPTION: , <br /> -�- 26 � ❑ Zoning District A' <br /> . ❑T s project is a new building or structure. <br /> his project is an addition/alteration to an existing building or structure. ❑ Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 <br /> t I ❑ ' etleolgddp( in/ . <br /> Shorelaridr attachent)fr <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .;',,,110','',' <br /> BASEMENT: 1 ST FLOOR: ❑ 0uslcr�entrit ii8rt11� <br /> 4, TOTAL SQUARE FOOTAGE: 4, (s�,d�trbance, <br /> in <br /> fllin[g/aCS} ' <br /> 2ND FLOOR: 3RD FLOOR: 4d���i,,(� 1i9: <br /> Review ,ocatton Survey; <br /> ESTIMATED CONSTRUCTION COST: $ and available options - <br /> (Please round to nearest dollar) "� '� �„)� :. ' <br /> 4g3. Is ri‘ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Ye iiio ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es o <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 o DDon't know <br /> 7. Is this to correct a violation? Oyes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 545-112(4/08) <br />