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LVIVINU f Crum I HrrLII,H I IVIV WWW.countyotdane.com <br /> PROPERTY OWNER INFORMATION <br /> • CUSTOMER TO PROVIDE <br /> Robert E. Daniel <br /> • -ADDRESS ❑Zoning Status; CUP; <br /> 10225 US Hwy 14,Mazomanie,WI 535 <br /> 60 Deed Restriction; CSM <br /> Variance(# ) <br /> • PHONE <br /> ADDRESS <br /> (608)334-3547 (608)334-3547 redanie159@hotmail.com NI Site Plan drawn to scale <br /> AGENT INFORMATION <br /> AGENT NAME CONTRACTOR NAME <br /> CONTRACTOR INFORMATION and includes dimensions <br /> Robert E.Daniel Cleary Building <br /> AGENT ADDRESS <br /> NI Site Plan including location <br /> 10225 US Hwy 14 CONTRACTOR• '0'' ,0 of well/septic <br /> • <br /> Mazomanie,WI fl Setbacks Paoli St) <br /> (City,State,Zip) .� Verona,WI 53593 <br /> PHONE <br /> PHONE 151 Site Plan approval from <br /> • • • 845-9700 applicable township. <br /> ADDRESS <br /> • ' F Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT El PARCEL <br /> • p Elevation of property <br /> NUMBE <br /> - '''' frontage drawn to scale.•TOWNSHIP: SECTION: <br /> • 0 Driveway permits <br /> D' (state,county,town) <br /> • • 1 <br /> CSM: • SUBDIVISION BLOCK/LOT <br /> 0 Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> New Workshop ❑ Zoning District <br /> • IN This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI Rural Address <br /> FIEWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 31.0 1.5 LI Wetland/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ <br /> Li permit <br /> 1,440.0 1 ,440.0 j, TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 2,880.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -+ and available options. <br /> (Please round to nearest dollar) ♦ ♦ $ 65 000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Q✓No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? (4rr.e.ew::) EYes ❑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 ONo <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 rNo [Don't know <br /> 7. Is this to correct a violation? [Yes INNo <br /> APPLICATION MUST BE SIGNED <br /> °° (Continue on Back) —► —► —► <br />