Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> (4A )C r 4)6--,(36[1 <br /> . ❑Zoning Status; CUP; <br /> OWN .ER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 33l 6 brri UCS,r,T-" ii pe = 4cT Mk t hAib 6.47: 53551 Variance(# ) <br /> HOME PH•NE CELL PHONE E-MAIL ADDRESS <br /> /1/ A i(60-;, : .,'j - r)5 /14/e-E ( K3 7O e2 ?4-1iOO. com <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ma_ t,i':'.IV ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 551+1e A6 Afte <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> 5Aine A ilVAWL. <br /> PHONE PHONE ❑ Site Plan approval from <br /> 5096e <br /> 4c; 4 f fe applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .��3Iy)E <br /> (', 40;-'?-'P E Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co,dane.wi,us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> I=1 PARCEL o 7$ frontage drawn to scale. <br /> NUMBER 07/4-,�6 63 73-o I`9 <br /> f Q` V 0' <br /> TOWNSHIP: SECTION: ^-� <br /> 16Co0M-Do' G&z 35 1�4. 1-o7., -1/4: R_lo_E ElDriveway permits <br /> ADDRESS: (state,county,town) <br /> 3316 eltu&ri P p&.. 42tcF/?P I4.4-ib� Ccs-/ .13�. ❑Sanitary permits <br /> CSM: LOT �� SUBDIVISION BLOCK/LOT (public, private) <br /> mat 14cre_LS <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6 APDE,U 5HEb U Zoning District <br /> . 111 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 Address <br /> EWER FTEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10.5 1 U Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> I use C6M <br /> )tea I 4 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) to measure <br /> 2ND FLOOR: 3RD FLOOR: d ista n;e, <br /> ao <br /> Li Review Location Survey LS <br /> ESTIMATED CONSTRUCTION COST: —I. —I. and available options. <br /> (Please round to nearest dollar) t1 t�000. 00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes Do ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [fres 2No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ®Yes ❑No <br /> ' 4. Has there been a zoning permit issued for this property in the past 5 years? EYes ao <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) Dies No ['Don't know <br /> 7. Is this to correct a violation? fives No <br /> APPLICATION MUST BE SIGNED <br /> REV(01/19 (Continue on Back) -4. —0. .-4. <br />