Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY s OW R NAME <br /> — e Pei D Kell e5L'1y ❑ Zoning District <br /> NERADDRESS (Number,Street,City,State,Zip) '' <br /> ‘119c( meadow v�'e lv IQ al /�T I eb 1- 535 7 ❑ Permitted Use? <br /> PHON E-MAIL 3,, E-MAILADDRESS <br /> ✓a L(37. <br /> ❑ Zoning Status;CUP; <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION Deed Restriction;CSM <br /> AGENT NAME CONTRACTOR NAME Variance(# ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS Site Plan drawn to scale <br /> c State,Zip) and includes dimensions <br /> (City, p) (City,State,Zip) <br /> PHONE PHONE ite Plan including location <br /> t of well/septic <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ Setbacks <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ❑ Site Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: <br /> ❑ PARCEL applicable township. <br /> NUMBER <br /> TOWNSHIP: S CTION: ((��' ❑ Rural Address <br /> y� / 1 - L 1/41/a: <br /> ADDRESS: Art.nydal� � /". (new/existing) <br /> CSM: LOT SUBDIVISION BLOCK/LOT door plans to scale <br /> (levation of property <br /> PROPOSED PROJECT INFORMATION ( frontage drawn to scale. <br /> PROJECT DESCRIPTION: <br /> ❑ Driveway permits f I,'l��yP , <br /> ' This project is a new building or structure. (state,county,town) <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> ❑ Sanitary permits <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑SEWER ASEPTIC c 1 7 •1I ( (public,private) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetiand/FIOOdplain/ <br /> 2-' Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -IP ♦ ♦ ♦ -.► -► $ 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 4 No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes 1 No ❑Don't know <br /> 3. Have you talked with the township about your project? W Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes l'No <br /> 5. This project is associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ®No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes ®No <br /> .L1:— (' 'S 51 PA 6 GS APPLICATION MUST BE SIGNED <br /> 545-112(1/08) I9-- (Continue on Back) -► --I• -o <br /> gr6,l/d rn, t- <br />