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<br /> <br />;;1 /0 liS- <br /> <br />ZONING PERMIT APPLICATION www.countyofdane.com <br /> <br />OWNER ADDRESS (Number, Street, City, State, Zip) <br />1004 STH 78, Mt. Horeb, WI 53572-3044 <br /> <br /> <br />E-MAIL ADDRESS <br /> <br />CONTRACTOR NAME <br /> <br />CONTRACTOR ADDRESS <br /> <br />(City, State, Zip) <br />Mt. Horeb, WI 53572-3044 <br /> <br />(City. State, Zip) <br /> <br />PHONE <br /> <br />PHONE <br /> <br />(608) 437-4553 <br /> <br />E-MAIL ADDRESS <br />mlprice@mhtc.net <br /> <br />E-MAIL ADDRESS <br /> <br /> <br />ACREAGE: <br />33.64 <br /> <br /> <br />PARENT <br />71 PARCEL <br />l.!J NUMBER <br />TOWNSHIP: <br /> <br />CURRENT ZONING: <br />A1Ex <br /> <br />SECTION: <br /> <br />Perry <br /> <br />%: <br /> <br />%%: <br /> <br />ADDRESS: <br /> <br />1359 CTH Z <br /> <br /> <br />PROJECT DESCRIPTION: <br />add Historic Overlay District zoning on Hauge Historic District parcels. <br /> <br />OThis project is a new building or structure. <br /> <br />OThis project is an addition/alteration to an existing building or structure. <br />SANITARY SERVICE: PERMIT NUMBER: <br />EPTIC <br /> <br /> <br />NUMBER OF STORIES: (Not including basement) <br /> <br />AREA TO NEAREST SQUARE FOOT: <br />(Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br />BASEMENT: 1 ST FLOOR: <br /> <br />~ TOTAL SQUARE FOOTAGE: ~ <br /> <br />2ND FLOOR: <br /> <br />3RD FLOOR: <br /> <br />0.0 <br /> <br />ESTIMATED CONSTRUCTION COST: <br />(Please round to nearest dollar) <br /> <br />-+ -+ -+ -+ -+ -+ <br /> <br />$ 0.00 <br /> <br />1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ........... <br />2. Is there a wetland or floodplain on or near the property? ............................................ <br />3. Have you talked with the township about your project and are they in agreement? .... <br />4. Has there been a zoning permit issued for this property in the past 5 years? ............. <br />5. Is this project associated with a rezone/CuP/varian~ce:e~~li!eO ) <br />6. Is a location survey required? (see reverse) .............................................................. <br />7. Is this to correct a violation? ............... ......................... ........... .................. .................. <br />FEB 1 0 2010 <br /> <br />545-112 (8/09) <br /> <br />tAm: <br /> <br /> <br />l-: ~~E'~lL(;;I!MEtn <br /> <br />CUSTOMER TO PROVIDE <br /> <br />o Zoning Status; CUP; <br />Deed Restriction; CSM <br />Variance (# <br /> <br />o Site Plan drawn to scale <br />and includes dimensions <br /> <br />o Site Plan including location <br />of well/septic <br /> <br />o Setbacks <br /> <br />o Site Plan approval from <br />applicable township. <br /> <br />o Floor plans to scale <br /> <br />o Elevation of property <br />frontage drawn to scale. <br /> <br />o Driveway permits <br />(state, county, town) <br /> <br />o Sanitary permits <br />(public, private) <br /> <br />STAFF REVIEW <br />o Zoning District <br />o Permitted Use? <br /> <br />o Rural Address <br />(new/existing) <br /> <br />o Wetland/Floodplain/ <br />Shoreland (attachment) <br /> <br />o ErosionControl permit <br />(slopes, disturbance, <br />filling/access) <br /> <br />O. Review Location Survey <br />and available options. <br /> <br />[]Yes [{]No ODon't know <br />[]Yes [{]No ODon't know <br />[l)ves ONo <br />[]Yes [{JNo <br />(leave blank if none) <br />[]Yes [)No [{lDon't know <br />[]Yes [{]No <br /> <br />APPLICATION MUST BE SIGNED <br />(Continue on Back) -+ -+ -+ <br />