Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ['S LL'-07" 2.-0-3"`' PO tA ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State Zip) <br /> �` o`� Deed Restriction; CSM <br /> 7 a 3 ; P� - Variance(# ) <br /> HOME PHONE CELrPHONE E-MAILADDR`ES <br /> Scfl 2 7 j S�� • 2 v e ' Q. e 'Tds. ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA Ems. CONTRACTOR NAME <br /> ssJ �,r, a �C Rib ❑Site Plan including location <br /> AGENT ADDRE CONTRALTO DRESS of well/septic <br /> it) 3 o/D s�>9 e.-0.,.^e_ cbr ' tA) c) (U _S cA Cz4.st, . <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Ee/4Q Li: //c CU ;S AJ S 53 S c2 <br /> PHONE PHON ❑ Site Plan approval from <br /> ,c3S' " .9 0`/32 , .) soy3 .._ applicable township. <br /> E-MAILADDRESS E-MAIL RESS <br /> / .h 9 A�'1 u�`i.e,/7(T Jc —, ❑ Floor plans to scale <br /> • <br /> PROPERTY/LGLATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTZ NING: ACREAGE: ❑ Elevation of property <br /> ❑PARCEL > frontage drawn to scale. <br /> NUMBER 0 VO-O7Z_ 'CQ �G._ fl � f . �. �� <br /> TOWNSHIP: SECTION: <br /> /2f o VI TH 05--t o 7• 1/. '/a'/a: ❑ Driveway permits <br /> ADDRESS: --7 / (state,county,town) <br /> 82)-5- -I1 U" ' go e N ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DES TION: <br /> '5 0 )l 14 p ❑ Zoning District <br /> . [ This 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 /> X r"`""R TIC (new/existing) <br /> HEIGHT IN F T: NUMBER OF STORIES: (Not including basement)pole 7 _ (9 k Le- , ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) I—, ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> _ I S �� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ , 2300 -T <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ENo ['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 ❑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 QNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />