Laserfiche WebLink
7 to i* 37S .3s <br /> l 6 0 t � <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www. ountyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Is‘ tgrZL hell'mA,.311/4) El <br /> CA-Li Zoning�s <br /> q <br /> M OWNER ADDRESS (Number,Street,City,State,Zip) Deed ct4 Zo o A d P Varia nce(# <br /> ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 40 8-S15'VA ka,,.1Azitr€.aLta ® • m4:,1 Comrn laSite Plan dra al <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes ions <br /> AGENT NAME CONTRACTOR NAME <br /> 6 Lt iI2M I 6u, l . n k ' C 4 L3 a,./d,vy ( <br /> e Site Pla inclu ing location <br /> AGENT ADDRESS <br /> CONTRACTORAbDRESS of well/s ti <br /> 0,0, ho x Ci o '1.20 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> 'i E 40uA : 5.3913 <br /> PHONE PHONE ❑ Site Plan - .. from <br /> 6108 - 5`15-Ci(1,11 1ec�8 -t�t5-ci7oo applica.`t•wn hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> G(,K p(,e v4,rP'—,, 1 J-Fror plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) [ 'Elevation of property <br /> PARENT PARCEL NUMBER: • 0 CURRENT A --ZONING: {� ACREAGE <br /> El NUMBER 0 701 1st ' 0016 A (I ! - , 8( , 0 G frontage drawn to scale. <br /> TOWNSHIP: //�� SECTION: <br /> �J'?OSS 1 tr�sus 1/4: 1/41/4: ❑ Drivewa e <br /> ADDRESS: n /� (state, n) <br /> Li�U e# K d ' ❑ Sanity p r 'ts•CSM: ii LOT SUBDIVISION BLOCK/LOT (pUbIIC (...g <br /> PROPOSED PROJECT INFORMATION r�� EW <br /> PROJECT DESCRIPTION: i <br /> NE20 4)0°4 Fi2,gmE S712ucvuiec` C zohitigI st ct <br /> . V This project is a new building or structure. U Perm" Se? 77. <br /> ❑This project is an addition/alteration to an existing building or structure. r <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> (SEWER SEPTIC �� # ° ' <br /> HEIGHT IN FEE4-va 18` NUMBER OF STORIES: (Not including basement) <br /> U Wei . ..•I•a <br /> Sht3l�mtl a e€tt} <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �Ct4IiTCllt <br /> q3-18 4, TOTAL SQUARE FOOTAGE: 1 (BSI•, +�-t t ;3ance, <br /> R `j «« <br /> 2ND FLOOR: 3RD FLOO 45-78 ;.'r. on Sumer <br /> ESTIMATED CONSTRUCTION COST: <br /> and a 1. <br /> 3 <br /> (Please round to nearest dollar) $ SQ 0 0 ,k4_•� 1 . " <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes JR3 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes -in No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes El No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <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 ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes LNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />