Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ 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 CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE <br /> 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/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ E• levation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER g <br /> TOWNSHIP: SECTION: <br /> /4: <br /> Yoh: ❑ D• riveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ S• anitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ti ''�� <br /> 7 9 x s -i-/ec:,.,�C U �� 4 Dist of <br /> ❑This project is a new building or structure. Ul wr <br /> ❑This project is an addition/alteration to an existing building or structure. :" "" <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> tip,ur d <br /> ditioni <br /> (SEWER (SEPTIC (ne ) <br /> HEIGHT IN FEE j NUMBER OF STORIES: (Not including basement) <br /> I .! 419 <br /> AREA TO NEAREST SQUARE FOOT: : or r frieng <br /> (Outside dimensions including unfinished area, attached garages n ove grade decks or porches) � . <br /> BASEMENT: 1ST FLOOR: ∎CJV �TCttil~r1Tt1#' <br /> 3 �` <br /> 6 / 4, TOTAL SQUARE FOOTAGE: 4. 4 fiance, 1 <br /> 1 <br /> 2ND FLOOR: 3RD FLOOR: AI ; t ' A� <br /> S. I Cl iew cair6r,srve y <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ ♦ ♦ 'and available <br /> .a t. , <br /> (Please round to nearest dollar) Q <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'? El 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) ❑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 />