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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 /> • Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) Deed Restriction;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> S/3 X ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I-Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) • -- backs <br /> PHONE PHONE LI Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) • vation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • <br /> 1/,/4: LI Driveway permits <br /> ADDRESS: (state,county,town) <br /> LI Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> �� <br /> PROJECT DESCRIPTION: /� All- 1( Lip <br /> P C -g�RN 7g� / (J .1 442' <br /> . ❑This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> � <br /> SANITARY SERVICE: PERMIT NUMBER: A e, g <br /> ❑SEWER ❑SEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �� � ° " <br /> BASEMENT: 1ST FLOOR: �a� r <br /> 4, TOTAL SQUARE FOOTAGE: 4, ?1 't'":-4�` <br /> 2ND FLOOR: 3RD FLOOR: <br /> ESTIMATED CONSTRUCTION COST: <br /> V rush <br /> G <br /> s a s0 <br /> (Please round to nearest dollar) -♦ ♦ !c.49 ©d� 07.2‘n- <br /> 1. <br /> 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 itrko ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Js ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ,1Go <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 _'go ❑Don't know <br /> 7. Is this to correct a violation? LI Yes PIQ <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/09) <br />