Laserfiche WebLink
227U <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER:INFORMATION ti�; '•;..:,::,''.._•.:::: :' `.14;;a .,3 iw r <br /> O NER NAMES CUSTOMER TO PROVIDE is <br /> j^, L Zonin g <br /> Status;CUP; <br /> OWNER D RESgber Stre tCState,Zip •eed Restriction;CSM <br /> M 31., ^"" " ", ) /4.4643• ma 537/ 8 a� rK) <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 531 +7i 3 `-7 ar il ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION,'—'7,.'g—',— ,,,, and includes dimensions <br /> C•kTRACTOR NAME <br /> IMMI . A _ _ Mb i r, l - S,Si.G. /� Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS lell/septic <br /> . — 73ib qrc,+ G ft"(19 <br /> (City,State,Zip) (City,State,Zip 0 Setbacks <br /> OMO IS ei o S n � � <br /> PHONE PHONE Z1 � �,�,,� ���J �- 'Ian approval from <br /> ID 1 applicable township. <br /> E-MAIL ADDRESS EaMAILADDRES <br /> WO •1 • I 1c/44.7,c ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.codane.wi.usn ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ING ACREAGE: ! r� P P y <br /> PARCEL a _ ( e 14 frontage drawn to scale. <br /> NUMBER D�g,�O$IO�IDt� <br /> TOWNSHIP'— SECTION: <br /> 4✓ / D i/a: 6E % : Ski ❑ Driveway permits <br /> 3�5� k'0 �� �.J ao0 u✓tA' <br /> CSM: LOT 3 SUBDIVISION I BLOCK/LOT LI Sanitary permits <br /> 55 (public,private) <br /> PROPOSED PROJECT INFORMATION ' '• * T EV <br /> ,Ii <br /> r-- <br /> DESCRIPTION: <br /> ❑This project is a new building or structure. . � ` <br /> his project is an addition/alteration to an existing building or structure. m n- <br /> SANITARY SERVICE: PERMIT NUMBER !.7 Q <br /> ❑SEWER ASEPTIC � <br /> 4"T <br /> NUMBER OF STORIES: of including basement) y ., <br /> 'S it . ,0 T <br /> tom. <br /> ® t i <br /> - AR • • NEAREST SQUARE FOOT: f, -1 <br /> 4 <br /> (Ou side dimensions includin.,,� i•hed area attached garages and above grade decks or porches) fi• t ;` <br /> & 4 A <br /> BASEMENT: I �j'7s' T FLOOR: <br /> ' ,j, TOTAL SQUARE FOOTAGE: I .° m. a 7 t ?. <br /> 2ND FLOOR: 3RD FLOOR: �� `��-3, �- �� <br /> �,,§'S's si '' <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) '♦ -4. --o. "♦ "♦ ♦ $ g/ O C ;*r ° ��' q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? LI Yes No LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? LI Yes ISlo LI Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? BYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes '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 /I No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes AJto <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i -* -o. <br />