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SUPPLEMENT to Web-App # <br /> ZONING PERMT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Andrew R Haas zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 411 Ash St,Sauk City,WI 53583 Variance(# �l2 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)370-2501 andyhaas77 @gmail.com 06 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Andrew R Haas Do-All Construction ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 411 Ash st, 1819 West Harmon Rd <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Sauk City,WI 53583 Lodi,Wi 53555 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 370-2501 (608) 592-4882 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> andyhaas77 @gmail.com Do-alldan @hotmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ID Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> E]PARCEL 0907-077-8330-0 ��, 2.52 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Roxbury i 1 /4: s E 1/x1/4. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 77 $s`- Fish Lake Road <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ` ❑Sanitary permits <br /> t (public,private) <br /> 8 <br /> PROPOSED PROJECT INFORMATION i D. <br /> a `� <br /> PROJECT DESCRIPTION: x" I " R <br /> House New Build , + <br /> . OThis project is a new building or structure. 131k � ? <br /> This project is an addition/alteration to an existing building or structure. 3 �c0 <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> ® Adder �r" , <br /> 13 - Z.0/q 00 92S (r w�as�) <br /> HEIGHT IN FEET: EWEREPTIC NUMBER OF STORIES: (Not including basement) • <br /> / L. U <br /> AREA TO NEAREST SQUARE FOOT: 0Bt*l} <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) R <br /> BASEMENT 1ST FLOOR' t I 0 � <br /> ._� Z TOTAL SQUARE FOOTAGE: $ }} <br /> 2ND FLOOR: 3RD FLOOR: ddd <br /> 33,E 3-1- 'Z v $i 4 <br /> ESTIMATED CONSTRUCTION COST: — a a' <br /> (Please round to nearest dollar) "♦ '♦ "♦ ♦ -� '♦ 'P 2 5 n, 0 C O- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑✓Yes llo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑✓Yes Olo ❑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 EINlo <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 Elo ❑Don't know <br /> 7. Is this to correct a violation? ❑ <br /> C� ✓ 'JYes o <br /> 2- 0/q - 0007. APPLICATION MUST BE SIGNED <br /> - (Continue on Back) -► -i -► <br /> 545-112(4/08) <br />