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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME f <br /> /A mm t fl) L e S <br /> OWNER ADDRESS (Number,Street,City,State,Zi ) ❑ Zoning Status;CUP;l,_ Deed Restriction;CSM <br /> HOME(N� C CELL PHONE 1i TG AILAD SS t-t/kE , 1 63-s-7. Variance(# ) <br /> g / 37-S&,'' ❑ 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 of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ 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://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL AI eX 3 7 / frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑ Driveway 0)OL) .4lS 1/<: '/A: ypermits <br /> ADDRESS: <br /> (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: SHED <br /> • This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: y to3 <br /> ❑SEWER SEPTIC a a a � <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ONE 7-' 9 4 r r � . <br /> AREA TO NEAREST SQUARE FOOT: �a ; <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: o � <br /> 4, TOTAL SQUARE FOOTAGE: 4 . $°,1 <br /> P ® e� � : <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) $ z� a <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes fagNo ❑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 'Jo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ►: o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />