Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.corn SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> r 1 t(.116e I L , cock mcu.( E . SczQ- <br /> OWNERADDRESS (Number,Street,City,State,Zip) Zoning Status;CUP; <br /> t `1l Luna Q. Cr k_. akOL (a(, -� Loi.. 53S 89 Deed Restriction;CSM <br /> HOME PHONE CELL PHONEariance # <br /> /�_�„y `p�� E-MAILEMAAd ESS ( ) <br /> (Lv0 of t� 9 (c -4S1 -1,-0 `..1 t SOn 521/4rSe , . t�.C" 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION <br /> AGENT NAME and includes dimensions <br /> CONTRACTOR' NAMEailf /� �(� <br /> AGENT ADDRESS en �'i,�` Y�"6 C Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) tal,-1 ti3.'Sfi 3ak <br /> (City,State,Zip) _ El Setbacks <br /> PHONE t-701)a Au lac tka 5 44 + <br /> PHOON,.(,PHONE El Site Plan approval from <br /> E-MAILADDRESS '""`"' _q a 3 -q0". -0 applicable township. <br /> E-MAILADDRESS <br /> c t4-P,9` azebos.com [Floor plans to scale <br /> PROPERTY/LOCATION<INFORMATION (http://accessdane.co.dane.wi.us/) <br /> 0 PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: [Elevation of property <br /> PARCEL <br /> NUMBER D`((o alit I —33 t-1-1V112 <br /> 1 "5 e-og (3, (c,C V frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 19 I ` 4- 59 etYnC f y4; <br /> �4. Driveway permits <br /> ADDRESS: (state, county,town) <br /> CSM: LOT 1\3c iC FeiSUBDIVISION BLOCK/LOT El Sanitary permits <br /> t--o-k- t a Nacd c,:. t--kvAdi,S (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> ge.p1ct(e Olck r 4 Ota W hQ on-Q- ❑ Zoning District <br /> • [`I-his project is a new building or structure. ('ref? e.em --) <br /> [This project is an addition/alteration to an existing building or structure. CI Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT INFE E+: tt NUMBER OF STORIES: (Not including basement) <br /> 4 (t y. s) f ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> +, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 3 6 0014 <br /> 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ '4. -4. '♦ -► -► $ aQt uoo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres QNo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes [No ©Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes [No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EN <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 EjNo [Don't know <br /> 7. Is this to correct a violation? [Yes [,�C No <br /> .--0V\ p03S <br /> Q APPLICATION MUST BE SIGNED <br /> REV(01/19) (0e27 _9 / (Continue on Back) -o. -4. <br />