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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 /> ` l ,c <br /> ��l � `" �y a n`-'d n ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Slate,Zip) <br /> •-� 3 .39- \ e v 0 �� l Deed Restriction;CSM ) <br /> C� V �Dl(,5 (.L�� Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS (/ <br /> 07 3 _It 5 7 f 2. "5(c02 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CO CTOR NAME <br /> c� v 'l a �}- ,( (/I. O ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES of well/septic <br /> 232,'f Ile.rvl vnl 'C <br /> (City,State,Zip) (City, te,Zip) ❑ Setbacks idriv PHONE PHONE ❑ Site Plan approval from <br /> 7 3 - ') 7 applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dene.wi.us/) <br /> PARENT PARCEL NU R: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1 (,l VV.IC 11(Y") 1%: '/a'/a: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: _ �� � ' <br /> . <br /> his project is a new building or structure. I <br /> ❑This project is an addition/alteration to an existing building or structure. 33� <br /> SANITARY SERVICE: PERMIT NUMBER: � �, z _ �� <br /> -: <br /> ❑SEWER ❑SEPTIC a ° W' <br /> HEIGHT IN FEET: 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) <br /> BASEMENT 1ST FLOOR: , ®I , �_�� <br /> 4, TOTAL SQUARE FOOTAGE: 4, �� �1 e � ` ,,' <br /> 2ND FLOOR: 3RD FLOOR: ,_ ,, <br /> ,(� ` <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) 'i '■ ♦ "� "� /' f �— �D _ , .,1�' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes p.g No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 4 Yes ado ❑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? i'es ❑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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —0 —► —► <br /> 545-112(4/08) <br />