Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 170 i- pt-Ni lC2E VJP-61\1 '2- — ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zip) Deed Restriction; CSM <br /> 2244 6t.,l✓rJ 7A-i Gt to-C-Ge Gofl7 E c 11Ve- V)1 5'5527 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> bbl6.eSc'0i0V i 4\ • $1-0 •cY( ve-e 6t1,1e∎IPtWE rn• CO'A C1 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME r� <br /> 'J r7�t 0 tit LAA (A'LPr F. @-17. lJ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4-115' S A i v t t✓-5 A* i <br /> (City.State,Zip) (City,State,Zip) ❑ Setbacks <br /> rpr,tAie, wt •102- 2642 <br /> PHONE PHONE — ❑ Site Plan approval from <br /> 7,62- 61?1- 1?33 <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> vA,16o e W 17APll p NE1.1-e1e-•a M ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us,7 <br /> PARENT PARCEL NUMBER. CURRENT ZONING: ACREAGE: Elevation of property <br /> 05e--,0 t r N2-oi -O 2-I 70, 2 1 +t frontage drawn to scale. <br /> le. <br /> NUMBER <br /> TOWNSHIP: SECTION <br /> +a 12?--12?--/q tit e. 3` ,�: \i\I �4 1/2: 145 Li Driveway permits <br /> (state,county,town) <br /> ADDRESS. <br /> 22H 61-al "'Me-- GAIL-CGS- co yr Er-OZ t,i t 5 '3527 <br /> U Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCIVLOr (public,private) <br /> 117-A7 (..i01— * 5 <br /> PROPOSED PROJECT INFORMATION • STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> N v'1 I"J-btivUM9 p•. , rail, ( aJ 'a, 1 c)<- + �G0 b WPu,S ❑ Zoning District <br /> ❑This project is a new bull.m-groucture. + 9pl b ❑ Permitted Use? <br /> 4This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER SEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> POOL, era) (40") DN E (i*) O.Wetland/Floodplain/ <br /> Stloreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErOSIOt1COt1tr01 permit <br /> BASEMENT 1ST FLOOR: <br /> Z ,1 ���-� �„� 1 TOTAL SQUARE FOOTAGE: j (SIOpeS,disturbance, <br /> ( r— filling/access) <br /> 2ND FLOOR- 99rt Pte-•N'4Ot7'SE Cam ) tyf/y /��O <br /> ( !� <br /> r I n n �F O s� 7J ir <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: O__, 7� dV and available options. <br /> (Please round to nearest dollar) ♦ ♦ --► ♦ ♦ lug <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? Li/Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? C 'Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? L`7Yes ❑No 222 <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 ZNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —+ —► <br /> 545-112(4108) <br />