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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER:INFORMATION,,,..;:> . ' _ tla?w;x,, :- .•r.-' !,;; CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> ❑ 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 /> Li Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE Li Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS 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 /> ,/; ,/,/: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , 4":4-.1; <br /> i TAB t E ,4.7❑This project is a new building or structure. !n 09 3 J +�—c.( kil k�i 3 : gg� <br /> / F i <br /> ❑This project is an addition/alteration to an existing buil • g or structure. ; ,� _,' - 44 <br /> SANITARY SERVICE: PERMIT NUMBER: l ' F, '`e o ` <br /> ❑SEWER ❑SEPTIC 1 I , `, <br /> * �HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 0 „,,r� -t �� � <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) t h <br /> BASEMENT: 1ST FLOOR: ® - a lid. s k_ <br /> 4, TOTAL SQUA E FOOTAGE: j a i[ '� m al, <br /> 2ND FLOOR: 3RD FLOOR: -- w ., ,, <br /> 16 0 /g176 �e- 1:�� a <br /> ESTIMATED CONSTRUCTION COST: � r.� <br /> �G♦ ♦ ♦ ♦ ♦ ♦ p ! (�Y(Please round to nearest dollar) <br /> - > S y S /9 DO t -d N✓4 L "C-2:-. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ❑No ❑Don't know C/' ... . _,i) <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ❑Dooiknow <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 blank if none) <br /> 6. Is a location survey required? (see reverse) Li Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545.112(4/08) <br /> (Continue on Back) —0, —► —+ <br />