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. . <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# ( <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Zoning Status;CUP; f'J— <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Variance(# ) f <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS f <br /> XSite Plan drawn to scale ! ,ISO <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> B4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) g Setbacks <br /> PHONE PHONE A Site Plan approval from A--"" <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of ro e <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: , ' , .' Driveway perm' Al <br /> ADDRESS: state,county own) <br /> CSM: LOT SUBDIVISION BLOCK/LOT e Sanitary its <br /> (public pr vat e <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: �i- � ' <br /> '-'5.-,r <br /> . ❑This project is a new building or structure. o , V � <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: =-4 <br /> ❑SEWER ❑SEPTIC ' , <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '� �-fr, -vLra-..,,,,, A..._ <br /> AREA TO NEAREST SQUARE FOOT: ,? <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) y <br /> BASEMENT: 1ST FLOOR: @ <br /> 4, TOTAL SQUARE FOOTAGE: 4, t' :' % - 1 ' <br /> :.� 9 8 ^a. �'' :s <br /> 2ND FLOOR: 3RD FLOOR: ?,; <br /> r`!:PirAebrts,4*0#4 Wi*rg 5 /4, <br /> ESTIMATED CONSTRUCTION COST: , ga <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or Take? ❑Yes allo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? CI Yes Et 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 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 /> 545-112(4/08) (Continue on Back) —0. <br />