Laserfiche WebLink
\ - 'o <br /> 7.._.00t( oes 3 / <br /> --i- t- \3 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME f I (� <br /> M Ca cs rna,41Q m f k c L L C ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> P. O. got (8 81oe kY� � 5357'7 Variance(# /a Q(s i7 ) <br /> }JAk '�j( <br /> tE PHONE I,E.j�;C CELL PHONE E-MAIL ADDRESS <br /> 6041- --:CO: ['Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Gst.)a 14e 1.4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> a'tv sM Q.; <br /> s <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 610C irk,(1.0c)s/ (,X <TS-1 q — 41,0o . <br /> PHONE / PHONE ❑ Site Pla ,,al from <br /> 4 os_14 9- Son 8 applicapit.. •nship. j� <br /> E-MAIL ADDRESS O E-MAIL ADDRESS <br /> C . <br /> • N.ill-,4 j . a C a -.., U Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Elevation of property G 6-i � <br /> PARENT PARCEL NUMBER: (� y, CURRENT ZONING: ACREAGE: n <br /> III PARCELNUMBER Og D�,f–Z 'gi" ah-o 6 ''3. 3"` frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ❑Drivevr <br /> mits <br /> putJ V►Q p <br /> m4ZJDI1 t /4: 1/4: <br /> (stat. dtll\r ty,town) <br /> ADDRESS: <br /> j edS-l A 1, wa 1:11 7-. .ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT •ubli�, private) <br /> 13 filo. I7 •iJ I l <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> P1QC.-Q ,I1/4)4a_u3 knOwte ©Ili) L ,4- ct.ec4 ` 4' of D Zoning District <br /> . ®This project is a new building or structure. Ep 6,-4.0,1Le D Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. ' tt <br /> SANITARY SERVICE: ^ U PERMIT NUMBER: Rural Address <br /> EWER [ EPTIC `V 34/&Co Z (new/existing) <br /> HEIGHT IN FEET: `t NUMBER Ot STORIES: (Not including basement) <br /> 1 —I 1=1Wetland/Floodplain/Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOT G ,, (slopes,disturbance, <br /> 1j`1�'} filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 76--"78. (Slip❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -1). -11. -o. -ii. $ 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? Dies ❑No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Kfres ❑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) Ores o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) — <br /> REV(01/19) <br />