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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Richard A. & Mary J. Wells ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 6711 N. Dunlap Hollow Rd. Mazomanie, WI. 53560 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 60g-767-2601 609-669-1569 wellselc @tds.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane-co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/4. 1/41/4. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 36 X SO Pole Shed ❑ Zoning District <br /> ®This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEVVER [EPTIC (new/existing) <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not induding basement) <br /> • ❑ WetlancWloo adn/ <br /> Eave 14 4 pitch 4/12 Peak 2141 �, Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErasionControl permit <br /> BASEMENT: 1ST FLOOR: j TOTAL SQUARE FOOTAGE: ,j, (slopes,tristurbance. <br /> filling/access) , <br /> 2ND FLOOR: 3RD FLOOR: 74500 <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes XIlo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 'Do ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes JC to <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) [i]Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ©No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />