Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App S <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> rotviNER NAME <br /> r Rj d �ar mS /o Vev non $ �Irco et tali QS (J Zoning Status;c -• <br /> ADDRESS ( sw.c cny,sl a,Zip) �l Deed Restriction t1 <br /> 1 303 1 nt y ( VIII 53555 Variance(ft 13(40: ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS , <br /> ()0g 5C 959'L-1-470S 338 I darcee.breuni• C ahco.03ry1 ®Site Plan drawn to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION and includes dimensions <br /> NTH CONTRACTOR NAME <br /> SLOB Co,rI vh-I\ 0 Site Plan induding location <br /> AGENT •• SS CONTRACTOR ASIS J <br /> N bQ g of welUseptic <br /> (coy,Sett tip) • <br /> � ice)Vj I 535 Setbacks <br /> PHONE PHONE <br /> ®Site Plan approval from <br /> (DOS YI3*O$7 al applicable e township. <br /> E-MAILADDRESS t#MILADDRESSwbcarpe(die 9.000 oo0 e grna►iI.Lem [n <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT «, T,:. ;-e3 :VTr.•'t: r•�T • ®Elevation of property I-1 PARCEL t 0aa O q©g— 07 3'olg ,. 0 ' N 1 A, 5 stage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> ADDRESS: ih: 1/41/4: ]Driveway permits <br /> rJ L state, <br /> / 6 1 iT n e-J BLOCK/LOT <br /> Q Sanitary permits <br /> Cart 13�o g LOT — <br /> — (pubkc,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT aCRIPTIOFM )I ✓' . Ft 1 F <br /> e�J CYU1oit1 Re. td6.nhaSt 1-tam <br /> } <br /> • g]This project is a new budding or structure. } t <br /> This is an addition/alteration to an existing building or structure. ' -°f s <br /> '$MI ITARY SERVICE: PERMIT NUM/ER: ' <br /> nIEWER I TC 1'3— ao1 -"ooD�S <br /> H�IN FEET ' I It NUMBER OF STORIES: (Net w+dIne bs m t) x <br /> AREA TO NEAREST SQUARE FOOT: _ ' <br /> (Outside dimensions ktcluding un nished area,attached garages and above grade decks or porches) °I l W;;,..,;',54.10. <br /> BASEMENT`. 1ST FLOOR t <br /> �7�I TOTAL SQUARE FOOTAGE <br /> 2ND FLOOR: �FLOOR: 2 ,.. 3 <br /> 730 y '„ <br /> ESTIMATED CONSTRUCTION COST: 1-1-001 ` ' <br /> (Please round to nearest dollar) —► ♦ ♦ ♦ ♦ ♦ u �' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes []lo QDon't know <br /> 2. Is there a wetland or tloodpialn on or near the property? QYeslo QDon't know <br /> 3. Have you talked with the township about your project and are they kI agreement? EYes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DA* }lo <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 alo ['Don't know <br /> 7. Is this to correct a violation? ['Yes <br /> APPUCATION MUST BE SIGNED <br /> 545-112(4/06) (Continue on Back) ■ -+ <br />