Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION OFFICE USE ONLY <br /> OWNER NAME <br /> -.TA 00-S NA- �Eary 621" 4 tA,'- 0 Z©nin ,Bistnct <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ' g <br /> 3 <br /> 7 3 �a it'a�/s /2 o,a•� Toy)A' ,l' P #v 4/1 5-3 r2 5 ,� Permitfed.Use?{x <br /> PHONE E-MAIL ADDRESS ° <br /> f 4"y- 5-260 ,iU Zoning Status;_CUP, <br /> AGENT INFORMATION CONTRACTOR INFORMATION W Deed Restriction .CSM <br /> CONTRACTOR NAME <br /> AGENT NAME variance # <br /> VG-A./,.,I 5 /ylvzp /p #6,v5!,u 4,,/dE/15 ,ZA.c • <br /> CONTRACTOR ADDRESS <br /> AGENT ADDRESS <br /> ® I� �Iat�{�Ca� ��flSG�le <br /> /io /r h �n s�. S cf f � <br /> / 1 ` a anudedmenons <br /> (City,State,Zip) (City,State,Zip) <br /> /r/Au ivn (Jz. S 3 S-!6 7 /✓Av 4,A k' .:F . 5-3C/7 Ste Pia,` clod 0 ovation <br /> PHONE PHONE of�ll/sE�t1C <br /> ' esV V f <br /> E-MAILADDRESS E-MAIL ADDRESS � oac � `�- <br /> . <br /> 0 / _ <br /> m <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) Site Plan app�__rr�oval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: t explicable town S ip I <br /> D PARCEL q %CJd/S� <br /> NUMBER d/oI- ?33 .- ' C `V• 4 <br /> TOWNSHIP: , SECTION: R.uratdress <br /> 3 3 1/4: 5 141/4: S 4-I til t <br /> 0 A ti/ , I ew oxlst: .40:11 <br /> ADDRESS: .,� ' 1, <br /> �/6 5 �Z o�i 5�'�t,,v J � �/i loo s <br /> 1 r pp.114�eaf o g . <br /> CSM: LOT SUBDIVISION BLOCK/LOT 7 � <br /> ooff�E]e a n rope sa PROPOSED PROJECT INFORMATION fronae rw o ce ' <br /> PROJECT <br /> .WDrivewa et 54 it s <br /> . a This project is a new building or structure. ? state,couta , ern) . <br /> ❑This project is an addition/alteration to an existing building or structure. ®-1 'SIry, lllts <br /> SANITARY SERVICE: PERMIT NUMBER: Re e i•-)Alf ei-/o-✓ <br /> ❑SEWER a SEPTIC u; A ' + � 'a„,vcr �" , <br /> t <br /> NUMBER OF STORIES: (Not including basement <br /> HEIGHT IN FEET ( 9 ) :W4tl010®.0tl� <br /> b elaar °attach meant) <br /> AREA TO NEAREST SQUARE FOOT: �� <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) . <br /> �Erc�st�r�L�flntro''lexrxarti s <br /> BASEMENT 1ST FLOOR: ` "P �. . 1. <br /> l TOTAL SQUARE FOOTAGE r open lSifliu`ance, <br /> 3 S Y 'r' C filling/access) �rt " <br /> 2ND FLOOR: 3RD FLOOR: i <br /> 7 5-To 6 <br /> oeucatlagurvey <br /> lew I <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and.avallab'le optfo rs ' <br /> (Please round to nearest dollar) �� ��"° - wn� - - FF <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ©No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes al No ❑Don't know <br /> 3. Have you talked with the township about your project? ❑Yes 0 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <br /> 5. This project is associated with a rezone/CUP/variance (petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes 2i-No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes 11.No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► -► <br /> 545-112(1108) <br />