Laserfiche WebLink
• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION OFFICE-'USE ONL"Y <br /> OWNER NAME <br /> \-°'^c+¢ oats.+• IM izgnirig Dlstrlct <br /> OWNER ADDRESS (Number,Street,City,State,ZIP) y ' - , <br /> \�J�� sr4'�vs,n � r s a a <br /> Voxorc, , �t �a'S��3 e❑fiPaoiot'ltse?•PHONE E-MAILADDRESSn <br /> 5...3''x''" <br /> �`1g— '�ao� ,� .boJ ¢z� c c�./f '∎rc. . Zorlrtg Status,CIJP, <br /> AGENT INFORMATION CONTRACTOR INFORMATION Deed Restrictton CSM. <br /> AGENT NAME CONTRACTOR NAME <br /> UarlalTCa( x . ) <br /> CONTRACTOR ADDRESS <br /> s <br /> rawn to ate;' tx AGENT ADDRESS 2 d,ncluddmenon <br /> . <br /> W - r r y(City,State,Zip) ' nib 1- s aio(cit y,State,Zip) <br /> Tailudng locn�' p ePlt0c �PHONE le C" l l lSPHONE <br /> SFr ;sri;, <br /> E-MAIL ADDRESS E-MAILADDRESS �s 4111 " <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wii.us/) Slte Plan approval from <br /> PARENT PARCEL NUMBER: ZONING: ACREAGE: s , . x <br /> ❑ PARCEL �•.. applicable ownshlp. . <br /> NUMBER 0�9a\O\OO�C O .cR�nel��� • \ s a-� it ika- i i ` - <br /> TOWNSHIP: SE TION: �. g '"^ e g ie i <br /> aPtt„.a„41drss N <br /> ADDRESS: <br /> 1/4: <br /> • r x m <br /> t 1 '' : 18,6t plans a s l , l <br /> CSM: LOT SUBDIVISION BLOCK/LOT 4. <br /> e tiQn b ropert�i' <br /> PROPOSED PROJECT INFORMATION frontage=dt wn fo scale <br /> PROJECT DESCRIPTION: p..* Z3 t � "3 <br /> 'Aa. \�' M''.al. cap r <br /> ❑This project is a new building or structure. °` -e sta �:;,�c�t t a n9 <br /> a - t <br /> .�This project is an addition/alteration to an existing building or structure. $ rs <br /> SANITARY SERVICE: <br /> PERMIT NUMBER: � � <br /> SEWER ❑SEPTIC _ ' <br /> • ,V 1 O ` r taw <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> \TJ �.� \ r <br /> ii -4 . <br /> . Shorelartd>(attacT meat) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> gyros o,T:;:c 0;ift earl► : <br /> BASEMENT: 1ST FLOOR: <br /> \� a� , TOTAL SQUARE FOOTAGE: ` , Topes' isfiur ance 4 <br /> fiIlintg/doc sS) <br /> 2ND FLOOR: 3RD FLOOR: 4. <br /> • <br /> ��\,P -��� Review Location Surrey x <br /> ESTIMATED CONSTRUCTION COST: Q� `O and�ai(a options <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ •P <br /> +tea : .,: ; � <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑YesC3 No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes L"J No ❑Don't know <br /> 3. Have you talked with the township about your project? (des CI <br /> 4 Has there been a zoning permit issued for this property in the past 5 years? CI Yes L 'l� <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 1 o ❑Don't know <br /> 7. Is this correcting a violation? • CI Yes 10 <br /> APPLICATION MUST BE SIGNED <br /> 54s112(1/08) <br /> (Continue on Back) --■' --0. <br />