Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME '1 <br /> k'c' 41' C?cc •I ('.lose/ ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> S e 4 S Poo d Vd • Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> IT- lace J 6) . .e,A,00 hfiv ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ORLANDO RODRIGUEZ <br /> 1ZceSrK ceZ. 4./6",ilk Z. (° 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTDR ADDRESS of well/septic <br /> /5/0 t:'v/,P)e,r." 54- ,iw 3 GS 3 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> SC.'n P(c.,s' 6 6., I. 5359 Z' <br /> PHONE PHONE ❑Site Plan approval from <br /> l t 0 5-93 - ,r 4 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS 'C,,^r.. <br /> ociO4 0 t ex�e`€7, ,_,� ,,�00 ❑ Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http://accessdane-co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 081010442222 SFR-08 0.468 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: Sec-1/G h <br /> `jC ,n cc Gi,/1`kG SaL,;h�wefr1/a:& C/T 1/a:ierit, ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> rT)P4 5 PooC) PPS, "r oc:)[1 ("y'/ 130rke' 9 Sanitary permits <br /> CSM: L T SU (VISION n BLOCK/LOT (public,private) <br /> 1 .� `c'yhE C-1 ceteS <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5 F7 x 1 ,2 fir. 13e-i c/c_ beck ❑ Zoning District <br /> ®This project is a new building or structure. U Permitted Use? YES <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: U Rural Address EX <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <10 )0 <br /> 1 U Wetland/Floodplain/ <br /> Shoreland (attachmenjOT 1D <br /> AREATO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> ,+, TOTAL SQUARE FOOTAGE: ,+, (slopes,disturbance <br /> ONTA;T <br /> 2ND FLOOR: 3RD 3RD FLOOR: <br /> filling/access) LWRD I <br /> 90'O 96 ❑ Review Location Siiii4TyUR3ANCE <br /> ESTIMATED CONSTRUCTION COST: and available options_ <br /> (Please round to nearest dollar) ♦ -► "� '-r ♦ 7800 p lav,USI <br /> SU RYE1 <br /> YES,POND 2Q 4 00516 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Q <br /> Yes No Don t know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeso ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? I JYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ONo <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) 0Yes No []Don't know <br /> 7. Is this to correct a violation? OYes ®No <br /> $59.60 APPLICATION MUST BE SIGNED <br /> REV(01119) <br /> (Continue on Back) -11. -► -4. <br />