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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME \ ` <br /> \)1 C1 1 Sh C ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ` t Deed Restriction; CSM <br /> 1305" (�cX ���e V\��C�9P RA, \ .ec 1�e tC1 P1 5`3 3 i Variance(# <br /> OM PHONE CE L PHONE E-MAIL ADDRESS <br /> ,ig l9 �� 39 ,ids 35 5,?9 `--SOS ( t"1 ❑Site Plan drawn toscale <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.usf) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1/4: 1/41/4 n Driveway permits <br /> ADDRESS: (state, county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> e ❑ Zoning District <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> J 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: Eros onControl permit <br /> 1 TOTAL SQUARE FOOTAGE: y (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 3 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -, c. , OD and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ ) A <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Peso ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑YesNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? .Wes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Peso <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) Ekes No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - <br /> 545-112(4/08) <br /> _l� . -1 <br />