Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION OFFICE-USE ONL"Y <br /> OWNER NAME <br /> it <br /> ✓`e )C GI- LA/ t' GJ vt Zoning Qistrict <br /> OWNER ADDRESS (Number,Street,City,Stat�Zip) _ r �, . <br /> 1 <br /> 7 U w G{'1- �"'J 'SiPer fitted use? :3 <br /> PHONE E-MAILADDRESS <br /> r <br /> Zoning Status,CUP <br /> AGENT INFORMATION CONTRACTOR INFORMATION , Deed Restriction CSM <br /> NT NAME n:71.,. ,-, CONTRACTOR NAME 1 Variance(# II }4�6f//t r J -- ` 1.AGENT ADDRESS CONTRACTOR ADDRESS Ae <br /> T/� /12C ,�� ian wn to sca[e; <br /> ( ay,State,Zip) �1.,`includesxdimensions <br /> �AA _ r c ( (City,State,Zip) • �, _. n w , "`�` , <br /> y <br /> UQNE PHONE ` (te p� F lritr,llfllR(��d1i11 i <br /> to - „ , s 7 ® ,, se [G�.�x <br /> ..._ C � �8/ � �i.�i�� key i.o f,_h i_ <br /> E- AILADDRESS J E-MAIL ADDRESS ,"x� � `• ' 4 K 4. <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLus/) e. to Plan approval from <br /> PARENT :ON ING: ACREAGE: L.L. `x�' <br /> PARCEL -� �rilfcahrdmit)st tp A <br /> Ej <br /> "sue"` s�-' " s �Yr"F Y" <br /> NUMBER > / *� �� .r <br /> TOWNSHIP: '• SECTION: <br /> ' , , ®®3 { • <br /> S /G,( hi. � L ✓4, s: ...773 "-� vs . .4. : _•ADDRESS: / / '� e.: ,('.XIS rf® t <br /> �-7 C� t 7-t-.- lbo plans'�e scale '# <br /> CSM: LOT SUBDIVISION BLOCK/LOT r ��� t <br /> t` 7 bf-- o <br /> PROPOSED PROJECT INFORMATIONattc? £ <br /> Cage drawn to acale <br /> PROJECT DESCRIPTION: ,/.1 r ' <br /> / � � <br /> �-_GE L ,//-4 tC f�``z-v.. - ��1�i �a�p��' Y <br /> ❑This project is a new building or structure. 1' state,,•county o nrn p <br /> This project is an addition/alteration to an existing building or structure. E$ f , <br /> SANITARY SERVICE: PERMIT NUMBER: 3Q [rnits <br /> ❑SEWER J1YEPTICr : g 3 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) Rd loodplainl <br /> 13 ( ' oreland a chm: ht) <br /> AREA TO NEAREST SQUARE FOOT: x q rtr <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: (C I TOTAL SQUARE FOOTAGE: 4, <br /> / sfi((tng7as , <br /> 2ND FLOOR: 3RD FLOOR: ,;; 4 k io <br /> 7(-, eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: = and avatlabe options <br /> (Please round to nearest dollar) ♦ ♦ '� ♦ ♦ ♦ 7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes LI No ❑Don't know <br /> 2. There is a wetland or floodplain on or near the property? ❑Yes ❑No Don't know <br /> 3. Have you talked with the township about your project? ®Yes LI 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 arezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? ❑Yes ❑No ❑Don't know <br /> 7. Is this correcting a violation? ❑Yes 0 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i •-► <br /> 545-112(1/08) <br />