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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 /> DC),-/ CA I <br /> a 6 ❑ Zoning Status;CUP; <br /> OWNER ADDRE (Number,Street,Ci State,Zip) Deed Restriction;CSM <br /> Variance(#_ ) <br /> HOME PHONE \\ CELL PHONE E-MAIL ADDRESS <br /> --)--7-9.1-1-S d-- ❑ Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENT ADDRESS CONT-•- .-ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ 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: CU ENT ZONING: ACREAGE: <br /> ❑ UMBER O / 0 . "4)- 0.70 O E— / ,.): frontage drawn to scale. <br /> TOWNSHIP: SECTION: / <br /> OJ e c-- C 1/4: N 'J1 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> -e-K go''l Or El Sanitary permits <br /> LOT SUBDIVISION BLOCK/LOT <br /> CS <br /> "i ) � (public,private) <br /> PROPOSED PROJECT INFORMATION ,° <br /> .,v <br /> PROJECT DESCRIPTION: O ��� � �.� �:, -� v� `�� �' <br /> ec 1. n v" A6£eSSO e °�w E <br /> . ❑This project is a new building or structure. 5, 4 ;. <br /> E This project is an addition/alteration to an existing building or structure. �� �. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> Ae� , <br /> 1 s� <br /> �(SEWER SEPTIC ,� � .�°'� <br /> HEIGHT IN FEE : NUMBER OF STORIES: (Not including basement) � �, <br /> s a eQoe <br /> -W44 r-a tel: <br /> AREA TO NEAREST SQUARE FOOT: , <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) `°`„¢ <br /> s t Aar t tl V,., . <br /> 1ST FLOOR: :s fires ii <br /> 4, TOTAL SQUARE FOOTAGE: 4 l <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: o - <br /> (Please round to nearest dollar) —10 $ (�( s ,r Q � a� <br /> , $'4'1'..' �° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there 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 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 El 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) ❑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 />