Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT tatr'.aAppa <br /> CU I MER TO PROVIDE <br /> OWNER NAME r <br /> ..--4-k-.6.-C:=> Gen � DiZon r g Status;CUP; <br /> OWNER ADDRESS(Number,Street,Cly.Slate,Zi) Deed Restriction;CSM <br /> (D02--c .L .W 14-1- el- De- Ili( 53S7S variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> S _r_.,(` 1 _.:Heti r- t� 3r0==.JoJA1i 45•Car aSite Plan drawn to scale <br /> and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ' $'('r COyC CA' C,t�✓'f A ra..4, 1ro.JS[1]/S'tef Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESSwell/septic <br /> 42S`t circ-K-41t—t_ 17. r c- C:T <br /> (CAy.Seale,bp) (City,Slate.Zip) Setbacks <br /> o uJI 5-3c7s - Oe tIJ Sas"7$ ,/ <br /> PHONE PHONE ['Site Plan ippYoval from <br /> Grog ,sit 1- 42-1(o applic a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 15.4ilE-rr„ oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:l/accessdane.co.dane.wl.us/) Elevation of property <br /> PARENT PARCEL NUMBER. CURRENT ZONING. A.REAGE. cierp p <br /> ❑PARCEL q - Q` frontage drawn to scale. <br /> NUMBER 65509-1/1- F]Yo-( F...MfTr <br /> TOWNSHIP: f SECTION- <br /> 'CO"Jti1 O • QBE-t-tS'1 ('1 Y.: - C: S� ❑Driveway rmits <br /> (Sl/ <br /> t`OUnty,town)GWn) <br /> ADDRESS: <br /> (�8 1.--0.4.49--'-f '-.C-. <br /> TCg N `U(1 TpJ7s 1=1 SBnItB BGSM: ILOT � ISLEDIVISION I BLOCK/LOT <br /> 0542 (P private) <br /> PROJECT DESCRIPTION: 1 i /STAFF REVIEW <br /> CIA E.. ,Aeb t Ttt9.-t CI �� toning District <br /> OThis project is a new building or structure. Permitted Use? <br /> %This project is an addition/alteration to an existing building or struct.7 `� <br /> SANITARY SERVICE: PERMIT NUMBER: j,,�1�t r/) D RUraI�"'-g <br /> EWER '1 EPrIC (new/ IStln <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Nd including basement) .'ter <br /> 1�' 1 0 Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorelapd (attachment) <br /> (Outside dimensions including unfinished area.attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion Control permit <br /> 10 O 4,TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fillingess) <br /> 1Od 0.0 <br /> 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION <br /> (Please round to nearest dollar)COSP. $ -0 c c�hand available options. <br /> 1.The property is within 300 feet of a stream or 1000 feet from a pond or lake? l/ Dyes Elk, ❑Don't know <br /> 2.Is there a wetland or floodplain on or near the property? ['Yes Pilo ❑Don't know <br /> 3.Have you talked with the township about your project and are they in agreement?., Wes ❑No <br /> 4.Has there been a zoning permit issued for this property in the past 5 years? es QNo <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) Elves ❑Don't know <br /> 7.Is this to correct a violation? Elveso <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -, i -+ <br /> REV(01119) <br />