Laserfiche WebLink
k <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Po11oc.,ki ?o,■)t` Cor ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street-City,State,Zp) Deed Restriction;CSM <br /> 535 S$0144 I t(31 Shrez+ , PaVr A1l1's 1).3.Z 5321(4 Variance(# ) <br /> /HOME PHONE LL PHONE E-MAIL ADDRESS <br /> 4N `M.-9136 .4 I 3.:11-8'1 O 3 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Pab(04_1 5t3t S ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS .� of well/septic <br /> etaa Sa J-141 1° c)-1-C(2 IL+ • <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Vie-5A- 1 1ic5 , V.)=- 5321( <br /> PHONE P NE CI Site Plan approval from <br /> 41`) `tS 3" ti O t© applicable township. <br /> E-MAIL ADDRESS E- IL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/ <br /> PARENT PARCEL UMBER: CURRENT ZONING: ACREAGE: Li Elevation of property <br /> El PARCEL Ova o%1t _ I <br /> 334 c( �_3 <br /> NUMBER C- (o,69 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 5 YI'ac'`/"it 33 1/4: SE 1/41/4: Svj ❑ Driveway permits <br /> �v1 (state,county,town) <br /> ADDRESS: <br /> 4'1% CAS A IT , CA Pr.,r r-c. - , U.a. 535`l0 ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �`� (p� P <br /> CIr ine A, Use 1 f FuQ( S-1/4_444 -t-o (c 4ctau y Lkt ( ' ° <br /> Nowa, <br /> CI This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. > 's L �� s <br /> F <br /> SANITARY SERVICE: PERMIT NUMBER: £Ruural Adc re 7: <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - <br /> �I ee• i-;`Y <br /> a - PONr <br /> r ) $ #®a ar # , qt <br /> , � <br /> AREA TO NEAREST SQUARE FOOT: * u <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) s <br /> t z�f0 )Qf t BASEMENT: 1ST FLOOR: O0: z a fC 4, TOTAL SQUARE FOOTAGE: 4, p a , <br /> 2ND FLOOR: 3RD FLOOR: <br /> Wit' . F z.:�, <br /> t v itgi ey <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) "� ♦ ♦ ♦ ♦ ♦ $ y a v�a11-O <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Ni No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes iZINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement') Yes ❑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) 1VJ Yes ❑i No CI Don't know <br /> 7. Is this to correct a violation? Li t <br /> Yes lal No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► --► --► <br /> 545-112(4/08) <br />