Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> . <br /> PROPERTY OWNER INFORMATION OFFICE iUSE ONLY <br /> OWNER NAME <br /> � �r J- <br /> / 24 /-10///new _❑ Zonlnr Uistrlct Y <br /> OWNER ADDRESS (N&umber,Street,City,State,Zip) :- „. $ : <br /> t i3e9.9 ,� t-o1" / C 11J,�.b w; .5 3�zS� if <br /> �P rmitt m <br /> :Use <br /> E-MAILADDRESS r x PHOONE 1 A <br /> U/ —,,:2•65-- QaSoZ ❑ Zoning Satu ,C= <br /> P <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restriction: CSM <br /> AGENT NAME CONTRACTOR NAME <br /> / i� t•a ian a(# ), <br /> AGENT ADDRESS CONTRACTOR ADDRE/1/:44" <br /> S <br /> IORIAn drawn fa sate: <br /> 0and1r clodesdimensions <br /> (City,State,ZIP) <br /> (City,State,Zip) } <br /> ❑fi ite plan Including location <br /> PHONE PHONE , ® W septi <br /> E-MAIL ADDRESS E-MAILADDRESS �zX g � '7 <br /> I�BGICSS r <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Safe Plan approV j from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: sus + 4 <br /> 0NUMBER vla/ogll_©ia- -° �f�-/ �.glo � �b)etc�v ns l <br /> TOWNSHIP: SECTION: . 4� ., 41 _,_ " r t <br /> !J 10 a c1dr 5-s , .<.' <br /> ,(�ri / L. 1/: /+ /. ... '/a'/:/vlc�' > /e is l lg� <br /> ADDRESS:. c, �'11_ // � r = : ; <br /> • ' ':/ / rr 7'ry 7?Q , - ti �ras� `:, ms`s r <br /> CSM: LOT SUBDIVISION BLOCK/LOT �!%, � �i01.M Std f Q4,. <br /> Ie'atlan pfpro(z? , <br /> PROPOSED PROJECT INFORMATION bra tape drawn to;sc le <br /> PROJECT D�ESCRIPTION: �_ � � <br /> Driveway permits _ <br /> LI This project is a new building or structure. l(state,coi ty,town) <br /> This project is an addition/alteration to an existing building or structure. s � � ; � <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> 'O ,a6 to ® mils t <br /> 0 SEWER ❑SEPTIC � � <br /> 'k 5r g. .F —F <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) r <br /> 9 'Ill etlal diFloodplaln, <br /> Shorelan l; aitacjil ent.)F <br /> AREA TO NEAREST SQUARE FOOT: ":••. * f <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) U i ErosionContlolpermit <br /> BASEMENT: 1ST FLOOR: , j. ... k . ..- , <br /> i/�dn 4, TOTAL SQUARE FOOTAGE: j, ,,, e ,, n,r <br /> 2ND FLOOR: 3RD FLOOR: fi(Iings ) a 3 <br /> ?8° <br /> U. ReviewkLocation Survey <br /> ESTIMATED CONSTRUCTION COST: '" nd <br /> -► -l. -► -► -► 1 antl at a�.. opt14.m1 <br /> (Please round to nearest dollar) aO°� <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 2(No ❑Don't know <br /> 3. Have you talked with the township about your project? ?'Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? AYes ❑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 ANo ❑Don't know <br /> 7. Is this correcting a violation? Li Yes C No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) .. ♦ . <br /> 545-112(1/08) <br />