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• --- , qt 0"7/5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 4-65?-72 ❑ 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 'DRESS of well/septic <br /> (City,State,Zip) (City, e,Zip) ❑ Setbacks <br /> PHONE 'HONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> El Elevation of property <br /> PARENT PARCEL NUMB CURRENTZONING: ACREAGE: <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1%: '/a'/a: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF -REVitSiit <br /> PROJECT DESCRIPTION: <br /> a�_ ❑ Zaning District <br /> . his project is a new building or structure. <br /> 9 ❑ F'ermttteci Used . <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ❑ Rural Address, <br /> ❑SEWER ❑SEPTIC (new/existtrlg) r" <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wefland/Flaodp! Inl <br /> Shorelar d (att c ent _ <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Eras�011VOntroflpermn <br /> 4, TOTAL SQUARE FOOTAGE: y (slopes,disturbance, <br /> filltraglatess . <br /> 2ND FLOOR: 3RD FLOOR: / �b az� <br /> !�- ,Q Review"Locatio Survey 4 <br /> ESTIMATED CONSTRUCTION COST: �� ��� and ava�labCe otxonS <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 ❑ o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑ o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ID Yes ❑ o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑ o <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blank' none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ❑ o ❑Don't know <br /> 7. Is this to correct a violation? DYes ❑ o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />