Laserfiche WebLink
_ ., J A ID3 <br /> ZONING PERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> "m 1-14,4,2- l l 0'i�04 El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,S t, ity,state,Zip) Deed_Restriction;-CSM_ <br /> 1- W�V .17d f Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI ADDRESS &K <br /> ite� x06 — - / 4.I Sh() .60� i Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA O NA E ,�,,r <br /> rO 14 Si4 ijt1 G. �M4( , �tdrs t JP<-- IAN I Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS �/// o well/septic <br /> 1ZU/ al!vt�troo s� 5A0-/1E <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE 1 r''•ite Plan approval from <br /> 267 PR IC a icable township. <br /> E-MAIL ADDRESS ,a E-MAILADDRESS <br /> S(/�ti Q G(.1(k/46WWJ• , , Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) levation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: P P y <br /> ❑ NUMBER (564 0 e5 '1 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 0OAv1 0 5— 1/4: /V 1/41/: iveway permits <br /> ADDRESS: <br /> (state,county,town) <br /> 31z t414u ¢c- 7714 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ��.1 anitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ,SF W <br /> PROJECT DESCRIPTION: <br /> All-Atid II 14'L <br /> 0 /1-l- t i“tiAf C ,' <br /> _Li This project is a new building or structure. I erta tt ,;q <br /> This project is an addition/alteration to an existing building or structure. k" s 4 <br /> SANITARY S VI ` z..Iat t- <br /> PERMIT NUMBER: <br /> S <br /> MEWER ❑ C / r r t : ,`: <br /> „it ' <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) x <br /> 3 01 3 `' (• J —f-w o Wets . •: � <br /> AREA TO NEAREST SQUARE FOOT: �� a td�' ,,e B ' <br /> (Outside dimensions including unfinished area, att ached garages and above grade decks or porches) ' 1 <br /> � 5 f,;.:.=.•'4s <br /> BASEMENT 1ST FLOOR: '- �� <br /> Z 5 4 Sts Z 5-lv j TOTAL SQUARE FOOTAGE: j, %:? M.: �` <br /> L � � � -� user as� � <br /> 2ND FLOOR: 3RD FLOOR: t 1* i l° .t° 1 s:�� `' <br /> a n ; f. v, <br /> ESTIMATED CONSTRU TION COST: a,, It �ig;.,� <br /> (Please round to nearest dollar) ♦ "'� ♦ "♦ '� '� ';,'%1 ,:,t;:=.t i. <br /> -�... -,:.:4i::::;,:!--,;toe;. <br /> 1. The property is within 300 feet of a stream or 1000 eet from a pond or lake? %Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the prope ? 'd�1Yes liel.No ❑Don't know <br /> 3. Have you talked with the township about your proje t and are they in agreement? 156es ❑No <br /> 4. Has there been a zoning permit issued for this prop rty in the past 5 years? El Yes caWO <br /> 5. Is this project associated with a rezone/CUP/varian a (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes CI Don't know <br /> 7. Is this to correct a violation? ❑Yes Zr.INI0 <br /> APPLICATION MUST BE SIGNED <br /> 545-112 aroe) (Continue on Back) -o. -+ -+ <br />