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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 /> JD � `� ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Nu Street,City, ate, ) i�,.p <br /> 03S:1 olit v\ it! A k W C Ltv ICLV , Lt; ! Deed Restriction; CSM <br /> 5�55� Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> .0.- 414—! . ,_; - 1- ; •h V►',V\ ° fit ' Li 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) ❑ Setbacks <br /> PHONE PHONE CI 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: CURREN ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHI SECTION: <br /> P- <br /> .1/4: %IA: CI Driveway permits <br /> ADDRESS: ` (state, county,town) <br /> a3%71 O \ate, ►�t'i 535s� <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: A. F Jr <br /> Cl�,cke� co� 5 )( tO <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: <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ –• e�f `!� <br /> (Please round to nearest dollar) a '7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? .ryes ❑No CI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes , 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 ,No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank jf none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 4 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 />