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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 /> ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE 'E-MAIL ADDRESS <br /> ❑ 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 ❑ 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: CURRENT Z ING: ACREAG ❑ Elevation of property <br /> ❑ PARCEL /'2//- 12-2'��O1—^ / / (% frontage drawn to scale. <br /> NUMBER (J / /`t % Q <br /> TOWNSHIP: SECT�QtJ: <br /> // "Jv� 1h: , IA: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION ,ST F I <br /> PROJECT DESCRIPTION: , f �D x Z / a = <br /> /�/� <br /> 1f( � (/ 0 1—L a : v tSft'!C( <br /> ❑This project is a new building or structure. :h ,, <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> y� <br /> SANITARY SERVICE: PERMIT NUMBER: ;�%�r l °—' ' `"-1V,;:.,'''' <br /> �� ` rO <br /> fSEWER %SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES:7ot 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 /> 3©lO0 4, TOTAL SQUARE FOOTAGE: 4{ SI0 W - F- .41"- <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: Q� //00t9 <br /> /� � � +'s�(Please round to nearest dollar) $ / ^V V / / a �. <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 ❑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? El 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 /> o !. � <br /> �f `/ c_ V✓ a, I ( APPLICATION MUST BE SIGNED <br /> ��ll //'may^ ^ / (Continue on Back) —► <br /> 545-112(4/08) C S GV\ g' <br />