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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NA bl‘treF/f) ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip)..-1-- <br /> Deed Restriction; CSM <br /> Sol' V-L .IV KoAf) Variance(# ) <br /> -a vi PHON. CELL P ONE E-M ADDRESS <br /> . '-s i35' ' A. 9"n O •6' - 1 - -J 4 0.6). <br /> Gosh ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTCit INFORMATION and includes dimensions <br /> AGENT AM CONTRACTOR NAME <br /> 4� 1 ( k] 1) S ❑Site Plan including location <br /> AGENT ADDRESS t 'NTRACTOR ADDRESS of well/septic <br /> (City, tate,Zip) i (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/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> /4: ,/4,/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT . SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ii Zoning District <br /> . ❑This project is a new building or structure. LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER FIE PTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (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 /> ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ w and available options. <br /> (Please round to nearest dollar) qv no• <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres ❑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) fYes ❑No ❑Don't know <br /> 7. Is this to correct a violation? Efres ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -► <br /> 545-112(4/08) <br />