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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 /> il'a Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) P Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS // ` <br /> �1 Site Plan drawn to scale 1 Z�/ <br /> AGENT INFORMATION CONTRACTOR :HFORMATION .nd includes dimensions <br /> AGENT NAME CONTRACTOR E <br /> Site Plan including I ati <br /> AGENT ADDRESS CONT-" TOR ADDRESS <br /> of�- v,.1) 1 � <br /> (City.State,Zip) (City,State,Zip) Setbacks 30/3 O t L ci <br /> PHONE PHONE III Site Plan approval from J (/ <br /> applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4... <br /> ,ELI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARC. NUMBER: CURRENT ZONING: ACREAGE: k1 Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: /� <br /> • <br /> ,/: 1/41 : kA Driveway permit /.f`J} <br /> ADDRESS (state,county, CID, <br /> ,IA S. permits <br /> C LOT SUBDIVISION BLOCK/LOT Ublic, •rivate) jj 1 <br /> •PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: J / ` r I I <br /> /� <br /> ❑This project is a new building or structure. � �`�- <br /> This project is an addition/alteration to an existing building or structure. r".... <br /> ".rz , F,� <br /> SANITARY SERV E: e8 �d e s4 � €�-� Al <br /> PERMIT NUMBER: � � �. $ <br /> SEWER ❑SEPTIC " <br /> HEIGHT IN F ET /g NUMBER OF STORIES: (Not including basement) ' - V 3 <br /> ' <br /> AREA TO NEAREST SQUARE FOOT: A <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) '3 f'`�: 4,... <br /> ( a e <br /> BASEMENT: 1ST FLOOR: •� I 14 <br /> ,l TOTAL SQUARE FOOTAGE: 1 <br /> 2ND FLOOR: 3RD FLOOR: �� � <br /> .�- - Y DVS k, . 3 <br /> ESTIMATED CONSTRUCTION COST: , , _ <br /> (Please dollar) —� ♦ —► —► -► .+ $ /r)s-c) <br /> Please round to nearest dollar , �_ <br /> 1. 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 ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes =1 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes '..TI 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 o ❑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 />