Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME ` <br /> L.. >� )E ri-) D R\c-. I v \ ❑ Zoning Statu • P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip <br /> U \�( ^n Deed R Iction; CSM <br /> 3750 1 •3\,:).1 w + OO `MA�{t IN NA 0 N <br /> HOME PHONE CELL PHONE MAIL ADDRESS <br /> - •■ 2%( S 41 ' 30 • ,'t \)& �;` JIM,L f�TV /a <br /> i Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> —_. t ,. <br /> IV/CI Site Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan royal from <br /> appl' a townshpy- <br /> i <br /> E-MAILADDRESS E-MAIL ADDRESS �- -�" <br /> ❑ Floor plar(to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane,co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE. ❑ Elevation of property <br /> PA <br /> NUMBER 0 19- oakb.1O%-5 \r 3 \ [ G frontage drawn to.scale. <br /> TOWNSHIP: SECTION: /'/ <br /> s W ❑ Drive permits <br /> ADDRESS: V r �� 1 1%:S �. /a'/a: (s e,county,town.) <br /> 3 7 • o % Ui' Mt .1)0.) W.I ❑ Sanita :-rmits <br /> CSM: 7 0 . LOT ` BDIVISION _ , BLOCK/LOT 2• (pug, private) <br /> PROPOSED PROJECT INFORMATION S FF REVIE3W`, <br /> PROJECT DESCRIPTION: \- \ r# . <br /> .This project is a new building or structure. <br /> ❑ errruttedUttl <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rclraf'. . <br /> ❑SEWER SEPTIC (new - isti o i <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 6 6 — 0 NVetla440.!--'!!..i.,1�,, r <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shc r ch : t0 <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ' °t `t° f `` <br /> ������ �'� TOTAL SQUARE FOOTAGE: I' " * '61 R a se 10. <br /> 2ND FLOOR: , <br /> 3RD FLOOR: �� <br /> v 0 B U Review r° � a ,ey r,�. I <br /> ESTIMATED CONSTRUCTION COST: . V <br /> (Please round to nearest dollar) 'r '� -+ "� Ir B�# t5 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes atlo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes l .(Jo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes -- Jo <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 rever e) ❑Yes gl.tlo ❑Don't know <br /> 7. Is this to correct a violation? )\Yes _, 4'o <br /> r?J I APPLICATION MUST BE SIGNED <br /> 545-112(tee) (((JJ (Continue on Back) —► —► -0 <br />