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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web•App# <br /> PROPERTY OWNER INFORMATION �,:... .-.z.;. '' '�` ':'-=u_� �`:,::: :,.=. r ;Jj - <br /> �• -- A CUSTOMER TO PROVIDE - <br /> OWNER NAME <br /> .Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Variance(# ) 13 <br /> Wt. . <br /> . <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ Site Plan drawn to scale ` //_... -os` <br /> AGENT INFORMATION <. CONTRACTOR-:INFORMATION. and ' dimensions <br /> AGENT NAME CONTRACTOR NAME — ' <br /> ❑ Sit- - . ' :uding location r <br /> AGENT ADDRESS CONTRACTOR ADDRESS °f well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> PHONE PHONE Site Plan approval a proval from <br /> ___ nshi°: <br /> E-MAIL ADDRESS E-MAIL ADDRESS ^� w�~'— <br /> ❑ Floor r plans to scale _ — <br /> PROPERTY/LOCATION'INFORMATION (http:l/accessdane.co.dane.wi.usn ' ❑ Elevation of property----- <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑ PARCEL ro .9.drawn..to-scale.-_) <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> ,/. ,/,/. g Driveway permit 4 <br /> ADDRESS: (state,county,000) <br /> Sanitary permits NA- <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> .ETA�, EyV 4 <br /> PROJECT DESCRIPTION: - s � 1 <br /> ❑This project is a new building or structure. a -f',,,7,'.1,.,.='."" <br /> • ❑This project is an addition/alteration to an existing building or structure. .. k <br /> t ft, p�i � ,. <br /> SANITARY SERVICE: PERMIT NUMBER: K t 1D�° ^ <br /> ❑SEWER ❑SEPTIC ' A t - , I`'� <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) - ' - g a % -' ,"f,, <br /> V� Atelai. iBT G( <br /> AREA TO NEAREST SQUARE FOOT: f y / <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ; <br /> BASEMENT: 1ST FLOOR: ) - . °Z �. ° . <br /> j TOTAL SQUARE FOOTAGE: ,, ' g. aI ° <br /> 2ND FLOOR: 3RD FLOOR: ' a� � <br /> P is B d•° G��tVi,ig i <br /> ESTIMATED CONSTRUCTION COST: . r - : °a � -1 <br /> (Please round to nearest dollar) "∎ -* --► —+ --► I <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 in No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? 'Yes — o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ANo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? DYes Si(No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ —► --0. <br />