Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> DL.',>YA (A))) S n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> � <br /> I�� I �I_� -ed Restriction;CSM <br /> MI-. -40,-e5W 1 53$72 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 691-CD- 14)23 mc,e(AAA's-s c r 45k 1 .Gin alS e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INi-ORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME \ 1 <br /> ( ka,Mea�ne;) d ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) LJ Setbacks <br /> PHONE PHONE Q S e Plan approval from <br /> Ijable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P Y <br /> 0 PARCEL frontage drawn to scale. <br /> NUMBER 044/0:506--N3 •5101-'-3" 14-4M-1( O.O.2t5 C4C <br /> TOWNSHIP: SECTIO, <br /> re��t �'� ' : '-VL 1/a: -5 V�i E Driveway permits <br /> ADDRESS: J (stole,coUtlty,town) <br /> /1 /� ►�C� 4.1/\3'Y <br /> CSM: LOT SUBDIVISIONfr BLOCK/LOT ❑Sanitary permits <br /> c1Q` t f T i G to y I` (?u.b)ic, private) <br /> PROPOSED PROJECT INFORMATION .TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> (..,. t DEci. Gid(Mr Esing 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 A dres <br /> EWER riEPTIC (new/e sti --- <br /> HEIGHT <br /> HEIGHT IN FEET: NUMBER OF STOR ES: (Not including basement) r <br /> L 2 + ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: ShOr/eiafid (attachment) <br /> (Outside dimensions including unfinished area, attache,arages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: 1 i P <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: - flllin CCS <br /> I - 0.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: 1. -ii. and available options. <br /> (Please round to nearest dollar) $ y QGd '1. <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? EYes [LNo <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) [fres No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes NNo <br /> 1 .....--- <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -to -0 -♦ <br /> REV(01/19) <br />