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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 /> ��Deed Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) speed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ite 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 f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ite n approval from <br /> a ica le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> N loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane,co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: I� <br /> Li PARCEL •:- _ •- •rawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: 1 1 1 7, Driveway permits <br /> ADDRE EA K, ,..,\ _ �4: �4�4: (state,county,town)- <br /> 1 — sanitary permits CSM: LOT SUBDIVISION BLOCK/LOT (public,private) .a!'P-43, <br /> )i�A �cxy <br /> PROPOSED PROJECT INFORMATION STAFF R 'EW <br /> PROJECT DESCRIPTION: <br /> ta-Zding District "°` <br /> 0 This project is a new building or structure. <br /> tutted'Use? `'` <br /> 0 This project is an addition/alteration to an existing building or structure. ,,.5 s lc) <br /> SANITARY SERVICE: PERMIT NUMBER: ''t 6 <br /> 0 SEWER 0 SEPTIC -' 1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> t• elan! :' - - s <br /> '47 •:'Shore �.4040 hment) <br /> AREA TO NEAREST SQUARE FOOT: l <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: �� � a €t �? <br /> TOTAL SQUARE FOOTAGE: ` l a ) i s 1 - <br /> t ill,e� e � <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: tUrBy ` <br /> (Please round to nearest dollar) "♦ '♦ "� ♦ ♦ '♦ avai . <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No 0 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No 0 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? 0 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 0 No ❑Don't know <br /> 7. Is this to correct a violation? a DYes ❑No <br /> G -)- Z�y 0 -7 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -� <br /> • <br />