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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 /> OWNER ADDRESS (Num City,State,Zip) Zoning Status; CUP; <br /> � Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CEL - .ONE E-MAIL ADDRESS <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> A ` /` CONTRA TOR NAME <br /> P_Su,5 (0- Oita r4iiNe.. - Site Plan including location <br /> AGENT ADDRESS CONTRA& •R ADDRESS of well/septic <br /> c3 c0 cJ t Gall ( 'A-Setbacks <br /> (City,State,Zip) (City,State,Zip) <br /> oto..A.t 50 uJ 7-t -5 PHO a Site Plan approval from <br /> PHONE pP <br /> Gde — 3 sI. - I qi-/ applicable township. <br /> E-MAILADDRESS E-MAIL AfDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) '� Elevation of property <br /> PARENT PARCEL NUMBER: CURB ZONING: ACREAGE: <br /> Li NUM ER 0109 3 s I R 660 I \co frontage drawn to scale. <br /> TOWNSHIP: ` SECT NI <br /> •P O`r 1 So S S 14: 141/4: v Dn�permits <br /> ADDRESS: (Sta , unty,town)G �' anit ermits <br /> CSM: LOT SUBDIVISIION BLOCK/LOT \ (p Ovate) <br /> U , <br /> PROPOSED PROJECT INFORMATION :STAFF REV EWN <br /> PROJECT DESCRIPTION: . .,', -' xM <br /> C_�� Zoning District <br /> . ❑This project is a new building or structure. ermitted Use? <br /> his project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT 4U (ne A°+ S ,- <br /> ASEWER SEPTIC ( V `ne u k <br /> HEIGHT IN FEET 1 NUMBER OF STORIES: (Not including basement) , s <br /> ❑FWe loodpiainf tr Y <br /> Sh nd (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached gafages and above grade decks or porches) tt7ls3errrttt <br /> Erosi' s <br /> BASEMENT: 1ST FLOOR: I <br /> 1 lob j, TOTAL SQUARE FOOTAGE: (slope disturbance,p ,s i <br /> filling ac ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> T O g <br /> Q'Revie L Cation Survey <br /> ESTIMATED CONSTRUCTION COST: /� 9 and aU bleiiaptions <br /> (Please round to nearest dollar) ♦ --► ♦ ♦ -N ♦ (O <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 ,I4No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes -14No <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) Li Yes 1No CI Don't know <br /> 7. Is this to correct a violation? ❑Yes 4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4. —► —t• <br /> 545-112(4/0B) <br />