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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 /> -I-1 tiv% L U R5-g_ 7Z tv.tJ 01 St,n'7'(4-1') ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) / S�' Deed Restriction;CSM <br /> S 7 ( E i W y /V i) , dm i i W' i c3Th Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> C, , 37 76, ,D. 5.75_/V6O © Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0 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 /> a'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation PARENT PARC evaon o property <br /> L NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> 0 PARCEL E� frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: CJ DrIVeWa <br /> • <br /> 1/4: 1/41/4: Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> PROPOSED PROJECT INFORMATION 3� <br /> PROJECT DESCRT '.41,,,,,-" <br /> . 0-This project is a new building or structure. ' � <br /> This project is an addition/alteration to an existing building or structure. �. <br /> ' <br /> SANITARY SERVICE: PERMIT NUMBER: � °, �, " k <br /> ❑SEWER SEPTIC " a { - <br /> HEIGHT IN FEET: ! 4 / NUMBER OF STORIES: (Not including basement) , <br /> AREA TO NEAREST SQUARE FOOT: .- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) �� . r«� �' 7 <br /> BASEMENT: 1 ST FLOOR: W g $ <br /> 1 C TOTAL SQUARE FOOTAGE: %� , <br /> 2ND FLOOR: 3RD FLOOR: J // , �� • <br /> / D G X 'jai: w fi', ` +�„ <br /> ESTIMATED CONSTRUCTION COST: $ �) � ' ` �� �'' <br /> --► -i0 --► $Q c s - !, a s , <br /> (Please round to nearest dollar) •p G� ;fin _ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ErNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 3Yes ❑No ,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 EiNo <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 Flo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -► -0 -0 <br />