Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> I- <br /> A I/l I •(1.e �/„ <br /> G- n rs-- Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) a {y� {�/L Deed Restriction; CSM <br /> as ?� 'I rI oC Ilea Q �1 `�_�� �� ✓ �''/J Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 3 w , i , W/ db ' ,: <br /> - Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> PHONE PHONE n Site pproval from <br /> appCa township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Q oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ion of property <br /> PARENT PARCEL NUMBER /�/ CURRENTZONING: d/d ACREAGE: P P y <br /> ❑NUMBER 061/ 07/ 81,�1 r ' 5 ♦ X p rontage drawn to scale. <br /> TOWNSHIP: ^ SECTION: 7 <br /> �1 e'SQA"t' n/ S A) %a: e. v%: SQL / e Drive y rmits <br /> ADDRESS: (/ (state nty,town) <br /> Z b i o Cale' 740 u , ii t n y-i S1f ' Sanitary permits <br /> 7 YYY CSM LOT SUBDIVISI.N BLOCK/LOT(: -->r I (public re I <br /> PROPOSED PROJECT INFORMATION A F REVIEW <br /> PROJECT DESCRIPTION r <br /> ea Ail -e U er — Flo I /0^$, oning Di riot <br /> [❑ his project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. rmitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER 'EPTIC (new/ .L9"-: <br /> HEIGHT IN FEET <br /> t--1 — NUMBER OF STORIES: (Not including basement) - <br /> etland/ oo.s ain/ <br /> horeland I achment) / <br /> AREA TO NEAREST SQUARE FOOT n(..4 <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ' -rosionControl permit S <br /> BASEMENT: 1ST FLOOR: <br /> I0 `I TOTAL SQUARE FOOTAGE: ! (slopes,disturbance, a.,._ O <br /> filling/access) ,1f4� <br /> 2ND FLOOR: 3RD FLOOR: 74, <br /> ESTIMATED CONSTRUCTION COST evlew availa le op Survey <br /> (Please round to nearest dollar) $ /a �m� 00 and avails le options.• <br /> ( J lip <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? FilYes ❑No Op on't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ❑No 4t on'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 12N <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank none) <br /> 6. Is a location survey required? (see reverse) Efres No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes I 'Jo <br /> L I <br />