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39r - <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed 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 /> Ite P n including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w I/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE It n approval from <br /> ap is le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> D F�perplans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1r ation of property <br /> PARENT PARCEL NUMBER: CUR NTZ NG: ACREAGE: p p y <br /> 0 NUMBER C L� ESQ 3 5• frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1%: 1/414: IVeWa ermits <br /> ADDRESS: (stat ounty,town) <br /> �i `J �� 11-. f 0 11 c —„ �] �anitarypermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> pu• , .rlvate) <br /> PROPOSED PROJECT INFORMATION ,- ST RFVIIEIA` <br /> PROJECT DESCRIPTION: <br /> :enramintilttedD:ddisruterssicset::! :::. ❑This project is a new building or structure. '❑This project is an addition/alteration to an existing building or structure.SANITARY SERVICE: PERMIT NUMBER: <br /> r <br /> ❑SEWER ❑SEPTIC xiSting) <br /> ,q.,.,, <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including f 4-•Wet n ,,loodOlaln/ <br /> AREA TO NEAREST SQUARE FOOT: Shor rid (athment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Ia ®ftE+� rol ermit <br /> ) 1 �- `-� e j, TOTAL SQUARE FOOTAGE: (SI• �disturba Ce, <br /> O filling/acG ss) .. <br /> q 2ND FLOOR: 3RD FLOOR: S 9 <br /> eview L b Oa ti•, <br /> ESTIMATED CONSTRUCTION COST: and availabre 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? ❑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 . o <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? DYes ,..S. No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —s <br /> 545-112(4/08) <br />