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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 /> ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑ 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.usn <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ NUMBER I Z co frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1/4: 1/41/4: ❑ Driveway permits <br /> ADDRESS: ddA� (state,county,town) <br /> ��4 rv` t_Q 0 nD el I ❑ Sanitary permits <br /> - CSM: LOT SUBDIVISION BLOC OT ry p cti <br /> bN(. ,� .� (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> �;PROti <br /> JECT DESCRIPTION: �sf ,�g - <br /> • ❑This project is a new building or structure. $q� <br /> Y� x ,Pr��_4II�'Hi �4 � <br /> ❑This proje is an addition/alteration to an existing building or structure. , <br /> SANITARY SERVI E: PERMIT NUMBER: ��� - x> <br /> SEWER ❑SEPTIC �� m . . <br /> HEIGHT IN FEET: \I NUMBER OFRIES: (Not including basement) k s , �� <br /> ° '1 i � � ; <br /> AREA TO NEAREST SQUARE FOOT: ' > <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) < t` ,-�.. <br /> BASEMENT: 1ST FLOOR: , ® �' <br /> �, TOTAL SQUARE FOOTAGE: ,� �i , ---g <br /> 2ND FLOOR: 3RD FLOOR: I <br /> 4 ;,,. z { i fi � p'# ';`a, <br /> ESTIMATED CONSTRUCTION COST: � ' <br /> (Please round to nearest dollar) -+ —∎ '* —∎ $ '�0 000 . ® : q. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0 es ❑ o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ilo ❑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? DYes o <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? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) —► —► <br />