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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION a ,> _ _ 1.14 ' 4:i4, . ; .-._,._ �.,?1_ . = CUSTOMER TO PROVIDE <br /> OWNER NAME p <br /> J6 h n R. f r q-( ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 112_ c{.c , . .r._ .6..- „> W 1 ,- - 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-IvfAIL ADDRE S <br /> ,v- _,q-k//(( joi.^frt.,e Q yhse/ <br /> �,c©n, ❑ 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 f well/septic <br /> (City,State,Zip) (City,State,Zip) IJ 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:l/accessdane.co:dane.wi.usn ❑ Elevation of rope PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rtY <br /> ❑ PARCEL BER frontage drawn to scale. <br /> NUM <br /> TOWNSHIP: SECTION: ❑ Driveway <br /> 1/4. ,/,/4. y permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION. -� <br /> PROJECT DESCRIPTION: ,. <br /> fl a gi0 ? <br /> V ' <br /> eCY . <br /> ❑This project is a new building or structure. <br /> LThiS project is an addition/alteration to an existing building or structure. 4 ff= _ K <br /> SANITARY SERVICE: PERMIT NUMBER: € t � � <br /> f ° • , z <br /> E]SEWER ❑SEPTIC �` �' i <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) " ; ---', a -° <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) � - <br /> BASEMENT: - 1ST FLOOR: ; <br /> 4, TOTAL SQUARE FOOTAGE: j � s ai <br /> 2ND FLOOR: 3RD FLOOR: �` - a� - <br /> ESTIMATED CONSTRUCTION COST: 4 <br /> (Please dollar) -► —► —► —► ♦ - . s ® e e 1� <br /> Please round to nearest dollara. " r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? li'Ye ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Na-Yes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 2-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 blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes 114o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Rio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />