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6� <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> A6S. `''= ❑ 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 AD•' SS of well/septic <br /> (City,State,Zip) (City,State, ❑ Setbacks <br /> PHONE PH• •E ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS A E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/a: 1/a1/a: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT CI (public, permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF`REVIEW <br /> PROJECT DESCRIPTION: <br /> AE 7)4 i e/,Z Cs. .a esE pc■T/3‘,/A—o/NS ❑ Zoning Distr€ct <br /> . This project is a new building or stru ure. ❑;Permitted 02§67:=1' <br /> se?f <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> ❑SEWER SEPTIC 2.d �� (new/existing) �0 1E <br /> HEIGHT IN FEET: <br /> /11-11 NUMBER OF STORIES: (Not including basement) �� <br /> ❑ Wetland/Floodpla rtf ' <br /> AREA TO NEAREST SQUARE FOOT: Sh©re1000�(atti )linen( . <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErOS14RContfol berm€ <br /> N�� /778o + TOTAL SQUARE FOOTAGE: + fillip esm distrlrE� r,€ce, <br /> 2ND FLOOR: 3RD 3RD FLOOR: fl[fing/access} <br /> �7 �"/� /7 O ❑:Review Location Survey <br /> ESTIMATED CONSTRUCTION COST and availala a 6010-ns <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ / 6f dd0 �y f <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? ❑Yes No <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# ) (leave blan 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 /> APPLICA ON MUST BE SIGNED <br /> (Continue on Back) -► ■ -► <br /> 545-112(4/08) <br />