Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE <br /> OWNER}NAME 1 <br /> ,r I.c h a G/ �rd e iA I'e (' <br /> OWIVERADDRESS (Number,Street,City,State,Zip) ❑ Zoning Status;CUP; <br /> / 6 r ,t+ \ / M OA Deed Restriction;CSM <br /> HOME PHONE I`I CEC/L PHONE E-MAIL ADDRESS Variance(# ) <br /> S'- °�+711-P • / ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME �. CONTRACTOR NAME <br /> �M,LtiG.t_-( �,i r M'C h(- t d-vt I it ❑ Site Plan including location <br /> AGENT 3 �DDRES$ � � CONTRACTOR ADD ESS� r� (4 of well/septic <br /> (.-',�6, ,t// 7731 / c' 4 <br /> (City,State,Zip) f (Cil State,Zip) LI Setbacks <br /> o`9c,, �-2 37171— ( rQ ,i wT SY5"7� <br /> PH NE PHON ❑ Site Plan approval from <br /> SY 1-----(E, rO ` 5,_ ry applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wi.us/) <br /> PARENT PARC NUMBER: CU RE TZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL /� f frontage drawn to scale. <br /> NUMBER 0 v �� (y• V O K <br /> TOW SHIP: / SECTION: <br /> V\vCet-i / a 1/4: 0 v■/ 'A1/4: J(.40? ❑ Driveway <br /> ADDR ss: ttl /� ,, (state,county,town) <br /> - 0 IXA V ,v l ❑ Sanitary permits <br /> CSM: LO SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: // , <br /> 49 y._,/�o(I ,..t..y ❑ Zoning District <br /> . Z This project is a new building or structure. <br /> Permitted Use? <br /> gi This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: J Rural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Io2 / ❑ 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 /> (,/6- r/ {/ /2_,O y/y 4, TOTAL SQUARE FOOTAGE: ,j, (slopes,disturbance, <br /> /� Q �1 /1 fillingiaccess) <br /> 2ND FLOOR: 3RD FLOOR: Z <br /> () ( q Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ `// O 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 ,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes )2I No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? •Yes l No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 2OD4Oi'•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 No ❑Don't know <br /> 7. Is this to correct a violation? <br /> Li Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —0. -0 <br /> 545112(4/08) <br />