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<br /> <br /> <br />ZONING PERMIT APPLICATION www.countyofdane.com <br />r;..~. . <br /> <br />E-MAIL ADDRESS <br /> <br />CONTRACTOR ADDRESS <br /> <br />(City, State, Zip) <br /> <br />PHONE <br /> <br />E-MAIL ADDRESS <br /> <br />CURRENT ZONING: <br />A -1 ~x <br />SEI1~ <br /> <br /> <br />ACREAGE: <br />S <br /> <br />%: <br /> <br />G %%: d \ <br /> <br />CSM: <br /> <br />D This project is a new building or structure. <br /> <br />D This project is an addition/alteration to an existing building or structure. <br /> <br />SANITARY SERVICE: PERMIT NUMBER: <br />o SEWER 0 SEPTIC <br />HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> <br />AREA TO NEAREST SQUARE FOOT: <br />(Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br />BASEMENT: 1ST FLOOR: <br /> <br />~ TOTAL SQUARE FOOTAGE: ~ <br /> <br />2ND FLOOR: <br /> <br />3RD FLOOR: <br /> <br />ESTIMATED CONSTRUCTION COST: <br />(Please round to nearest dollar) <br /> <br />-+ -+ -+ -+ -+ -+ <br /> <br />$ <br /> <br />1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ........... <br />2. Is there a wetland or floodplain on or near the property? ............................................ <br />3. Have you talked with the township about your project and are they in agreement? .... <br />4. Has there been a zoning permit issued for this property in the past 5 years? ............. <br />5. Is this project associated with a rezone/CUP/variance (petition/appeal # ) <br />6. Is a location survey required? (see reverse) .............................................................. <br />7. Is this to correct a violation? ....................................................................................... <br /> <br />545-112 (4/08) <br /> <br />CUSTOMER TO PROVIDE <br /> <br />D Zoning Status; CUP; <br />Deed Restriction; CSM <br />Variance (# <br /> <br />o Site Plan drawn to scale <br />and includes dimensions <br /> <br />o Site Plan including location <br />of well/septic <br /> <br />o Setbacks <br /> <br />o Site Plan approval from <br />applicable township. <br /> <br />o Floor plans to scale <br /> <br />D Elevation of property <br />frontage drawn to scale. <br /> <br />o Driveway permits <br />(state, county, town) <br /> <br />o Sanitary permits <br />(public, private) <br /> <br />DYes 0 No D Don't know <br />DYes 0 No 0 Don't know <br />DYes DNa <br />DYes DNa <br />(leave blank if none) <br />DYes DNa o Don't know <br />DYes DNa <br /> <br />APPLICATION MUST BE SIGNED <br />(Continue on Back) -+ -+ -+ <br />