Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> •WNER NAME <br /> Zana Bajalan <br /> _ oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 408 Powers Ave.Madison,WI 53714 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (414)581-7719 zanajassim @gmail.com Ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Including location <br /> JAGENTADDRE . CONTRACTOES of ptic <br /> (City.State,Zip) (City.State,Zip) tbacks <br /> PHONE PHONE • Site P roval from <br /> appli township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> Upt‘r.plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) vation of property <br /> PARENT 1 PARCEL NUMBER: C RRENTZONING: ACREAGE: p P y <br /> ❑PARCEL NUMBER j <br /> --7c ,008/0710-051-2811-9 _3 0 0.12 frontage drawn to scale. <br /> SECTION: <br /> /T-eWNSHIP: <br /> Town of Blooming Grove 5 1h: NW WA,: NE ❑ Drive ermits <br /> ADDRESS: (stat unty,town) <br /> 408 Powers Ave. Madison, WI 53714 <br /> . ❑Sanit_% • -rmits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 11 6 (pu• . , •rivate) <br /> PROPOSED PROJECT INFORMATION S F REVIEW <br /> PROJECT DESCRIPTION: �) <br /> Expanding a deck attached to the back of the house(Ground Floor) I S q 15 Wing District <br /> ❑This project is a new building or structure. Pitted Use? <br /> This project is an addition/alteration to an existing building or structure. l/ <br /> SANITARY SERVICE: PERMIT NUMBE : al Ad• - s <br /> NEWER [EPTIC (new/-xistin• , <br /> HEIGHT IN FEET: 1/ NUMBER OF STO IES: (Not including basement) <br /> 1.0 ❑ Wet : d ":•dplain/ <br /> Sh• - nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1STF1 ❑ Erosi• Co of permit <br /> d` j TOTAL SQUARE FOOTAGE: j, (slope .ISturbance, <br /> 2ND FLOOR: 3RD FLOOR: 1 \ <br /> filli • ac•ess) <br /> [v\�` ❑ Revie tion Survey <br /> ESTIMAT D CONSTRUCTION COST: <br /> (Please round to nearest dollar) -+ - ♦ -* -+ $ 1,000.00 and ble Options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes IgNo/#1&on't know <br /> 2. Is there a wetland or floodplain on or near the property? aes ig No Don't know v <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 12 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 rNo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) - -► --I• <br />