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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 /> so/kJ __<71,407e,/ ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Numbs Street,City,State,Zip), Deed Restriction;CSM <br /> ) lg.0 Acc•r4 CO Variance(# ) <br /> HOME P NE CELL PH E E-MAILADDRES= ' <br /> Ze C rV f~-� 2 r '?13 a,,,_4,---/! C°Jfi Ca-❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRA'TOR NAME <br /> 6wr i�i'/vim ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (Ci ate,zip ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://acc:essdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL e Z Zb 2 >g•-k°3 <br /> frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑ Driveway <br /> Y4: 141/4: permits <br /> ADDRESS: <br /> (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> .This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> ❑SEWER ❑SEPTIC (rneW/exiSting) <br /> HEIGHT IN FEET: NUMBER CIF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Sboreland (attachment) <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 /> ❑ Erosion r ontrol permit <br /> 4, TOTAL SQUARE FOOTAGE: ,`, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ and available options. <br /> ♦ ♦ <br /> (Please round to nearest dollar) S (y7 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Na ❑Yes *lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? N d ❑Yes kallo ❑Don't know <br /> 3. Have you talked with the township about your projecct and are they in agreement?j.Wf (es ❑No <br /> ' <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? AYes ❑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) UYes 0.No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes c No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ -+ -* <br />