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57, 2- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWN NAME, <br /> twit I ❑Zoning Status; CUP; <br /> OWNN RADDRESS (Number,Street,City, tale,Zip) Deed Restriction; CSM <br /> HOME PHONE vc U'�E�P O ' E-MAILAD ��-)6 Variance(# ) <br /> /LA �% I 4- ' i. Ai i• &. fit II IA ❑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/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL q frontage drawn to scale. <br /> NUMBER O aU ''�]l <br /> TOWNSHIP: SECTION: <br /> 1/a: '/at/a: ❑Driveway permits <br /> P) yl'nt SPh n�S (state, county,town) <br /> ADDR SS: <br /> ['Sanitary permits <br /> d . CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJEWSCI3IPTIOlst rt,�^ <br /> .n,5,Ll/'1 1 reck ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> p.This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER )EPTIC (new/existing) <br /> HEIGHT IN F T: NUMBER OF STORIES (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1 T FLOOR: <br /> Q ,, •TOTAL SQUARE FOOTAGE: 4 (Slopes,disturbance, <br /> 1 filling/access) <br /> 2ND FLOOR: D FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $44% S� and available options. <br /> (Please round to nearest dollar) ♦ -► ♦ ♦ -0. ♦ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes W o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes Vi o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es ❑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 g!.o ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ►1No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />