Laserfiche WebLink
a, <br /> ZONING PERMIT APPLICATION .countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO - •OVIDE <br /> OWNER NAME n <br /> 0r ee- d' . .CI c / Gorman ❑Zoning St. s; CUP; <br /> O NERAD/D'RESS (Number,Street,City, Zip) ,/ Deed -- friction;CSM <br /> �'a i .514-A. flack, 'lief() w 1 5a35ci3 Vari.- e(# ) <br /> HOME PHON CELL PHONE E-MAIL A II DREA <br /> 33a- 4891 '!a-7glpl III 5 i rnne @1d5.'td <br /> ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTR• TOR NAME <br /> Si a Plan including location <br /> AGENT ADDRESS OTI\e CONTRA TOR ADDRESS of well/septic <br /> (City,State,Zip)ADDRESS <br /> (City,Stat-.Zip) etbacks <br /> PHONE PHONE ❑Site Plan a oval from <br /> appli a township. <br /> E-MAIL ADDRESS E-MAIL Al DRESS ❑ <br /> loor ns to scale <br /> PROPERTY/LOCATION INFORMATION (http J/accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: P P y. <br /> ❑PARCEL (�8 Q/� n (� �/ /2.?0 frontage drawn t tale. <br /> NUMBER ©� �/ "(�%r �` /"C �� ` n O <br /> TO SHIP: SECTIO : r <br /> f`t"e ro 5E f I 1/.:s I` ,,4: s ❑Drivew ermits <br /> ADDRESS: (sta ,county,town) <br /> S21 LI 14t 4L Qom t UexD i i UJ 1 535q,3 <br /> CSM: LOT SUBDIVI'ION BLOCK/LOT ❑Sanitary p its <br /> 3 0a ♦ I 3ublic rivate) <br /> PROPOSED PROJECT INFORMATION 4zr <br /> PROJECT DESCRIPTION: IS. X / ° <br /> ❑This project is a new building or structure. ` . <br /> E <br /> ,his project is an additio .Iteration to an existin. building or structure. <br /> SANITARY SERVICE: PERMIT UMBER: °t0■ ) .. '1°,1° <br /> .EWER D.EPTIC ". <br /> HEIGHT IN FEET: 1 I NUMBER OF TORIES: (Not including basement) "° z <br /> AREA TO NEAREST SQUA-E FOOT: ' ;' <br /> (Outside dimensions including unfinished area,attached ga ages and above grade decks or porches) r <br /> BASEMENT: 1ST FLOOR: � � � �� �{ �} <br /> � 4. TOTAL SQUARE FOOTAGE: •4' • =1' +' r■ <br /> 2ND FLOOR: 3RD FLOOR: '&cA :. <br /> ESTIMATED CONSTRUCTION COST: 12 <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1001 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? •l -s f No ❑Don't know <br /> 3. Have you talked with the township about your prof:ct and are they in agreement? 1r4 es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? MI es 'JNo <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ENo ❑Don't know <br /> 7. Is this to correct a violation? DYes No <br /> r________ APPLICATION MUST BE SIGNED <br /> 545-112(4/08) �� (Continue on Back) -■ <br />