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vt (( 1 ,Lip <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME <br /> 0 vv.\ U na. ❑Zoning Status; <br /> E ADDRE (Number Street,city Zip) CUP; <br /> 1 Deed Restriction;CSM <br /> Os l'4 t#OV 5( 5 )US1,1. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI}ADDRESS <br /> tiOa 'S'514 5QV V I - LA.Um-" t9 ` rn, .\'t•c.0'''\ ❑Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ama Builders LLc ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> P.O.Box 227 <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> Brooklyn,WI 53521 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 444-6702 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> kjama©litewire.net ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL 311 - 091-26404 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Ys: 1/4 1/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,p <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> Making second story full 8'walls on all sides. Installing new trusses and roof. ❑ ZortingDistrict <br /> • ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑,Rural AcklCess <br /> EWERPTIC Oew/e <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2.0 0 Wetlla. <br /> AREA TO NEAREST SQUARE FOOT: Shoreland'.( , meht) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) . , <br /> ❑:Erosioneontrol permit <br /> BASEMENT 1ST FLOOR:91253 g 3� 4, TOTAL SQUARE FOOTAGE: j (siopes,distutbancec <br /> tAlit�i/aocess) <br /> 2ND FLOOR: 3RD FLOOR: W <br /> 0 ReWew Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ Q �)�, and available options. <br /> (Please round to nearest dollar) W le)t goo <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓❑Jo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies Fo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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 ✓ilo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 tl (Continue on Back) -► <br /> a <br />