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ZONING PERMIT APPLICATION wcountyofdane.com SUPPLEMENT to Web-App # <br /> ww. <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> OWNERADDRESS (Numbpr,Street,Cit State,Zip) . ❑ Zoning Status;CUP; <br /> 7660. (U` rn- <br /> HOME � �d� s .? // Deed Restriction; CSM <br /> PHONE CEL PHONE E-MAIL DRESS // Variance(# ) <br /> 6 b • 0 3/S0 (cC 8 C ' 7/g° ❑ 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 <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.wLus/) <br /> ❑ PARENT PARCEL NUMBER: CURRENTZO NG: ACREAGE: ❑ Elevation of property <br /> PARCEL E / _ Y- / <br /> NUMBER 090q°2-3���P7 ` � S frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> V 1'e ill VI a 0 Z 1/a: %/a,/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> S <br /> � 7 S (A) 6“). <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION , <br /> PROJECT DESCRIPTION: + � <br /> al lc:l_ / a d z i Ski ' ,U mg, <br /> ❑This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. �� <br /> SANITARY SERVICE: PERMIT NUMBER: 't O ' , ,'. s ;;£ <br /> SEWER SEPTIC t '3 €3 " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ` 4, <br /> AREA TO NEAREST SQUARE FOOT: ° ` °� } <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: • s � � <br /> l TOTAL SQUARE FOOTAGE: $ s , e rf <br /> 2ND FLOOR: 3RD FLOOR: ° <br /> � q a . It' ; <br /> ESTIMATED CONSTRUCTION COST: <br /> ti l' <br /> (Please round to nearest dollar) ♦ '► "► "► ♦ ♦ /� O O ci ° n'a �,wir• ,', <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 El/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 gNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blan if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 011No El Don't know) <br /> 7. Is this to correct a violation? ❑Yes 'No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ ■ —► <br />