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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNE' AME <br /> /r Q ❑Zoning Status;CUP; <br /> OWN R.,. S (Number, treet,City,State,Zip) w v` /�� <br /> —/7 (off /I '-/�//[/ Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> r JO--- 6C/ ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT AME / /l� CONTRA TORN E // / <br /> ( C (- `JC 1 '/ - ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR A RES ' ST of well/septic <br /> 33/ L - � <br /> (City,State,Zip) (cay, race zip ci�� t�Q ❑Setbacks <br /> PHONE PHONE a ❑Site Plan approval from <br /> 0 c — � 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 /> ,_�_ ,�W∎1RENT PARCEL BER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> �//�PARCEL O j �V-(,GS6-,0 frontage drawn to scale. <br /> rum NUMBER „ <br /> TOWNSHI : SECTION: <br /> Pi( ,/4: 1/41/4: ❑Driveway permits <br /> ADZE . (state,county,town) <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT WRIe TIO)N: / " <br /> 'C�C.�/ / ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address <br /> EWER EPTIC (new/existing)" <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 0 Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attacheL drages and above grade decks or porches) <br /> /wages ErosionControl permit <br /> BASEMENT: 1ST FLOOR: ,. <br /> 4, TOTAL SQUARE FOOTAGE: ,l (slopes,disturbance, <br /> c-(i 2ND FLOOR: 3RD FLOOR: / (A filling/access) <br /> /�/� "// 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: _+ -+ and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? tElYes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? jam► -s ❑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 Nlo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes pQJo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />