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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNEM C) V.e <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> a,OA La 1Ge ■..x_ co ■S c,.e,-,\ S--\rek.)%4A-es-. u•S� 6 S5S9 Variance(# ) <br /> HOME PHONE CELL PHONE E- AILADDRES <br /> �c � YJ! - 10571 4,0 S—"N11 -.assy 0fc,c . 4* \el' ' Q 1ti 'L+&C-.Lc' ❑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/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWN WP- SECTION: <br /> '/<: 1/41/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> I A A C)0 CA- - ' V-e- <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> - _ i (public, private) <br /> PROPOSED PROJECT INFORMATION I = AMFF.REVIEW--; `' <br /> PROJECT DESCRIPTION: <br /> ci honing strict <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: LI 1=turalAddress , - <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 2-7 1 LI a,..4... ,,.,.plain <br /> Sh r ' • - -chment); . <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 0 ErosionControi permit <br /> BASEMENT: • 1ST FLOOR: <br /> )°133 S `� + TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> �► ,�� .t--4 G� iltlnc�l�ss) <br /> 2ND FLOOR: - • 3RD FLOOR: <br /> �'y y <br /> `� O�1�© � O��R.- � {«�bon, i�ry <br /> ESTIMATED CONSTRUCTION COST: -► -► �. : .jDppg r <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 ONO ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ENO ['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 ❑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 ENO ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ENO <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► -♦ <br /> 545-112(4/08) <br />