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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 /> Stuart Keith <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 6334 Hillsandwood Road, Mazomanie,WI 53560 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)795-2775 (608)219-8183 stuartk @centurytel.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑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 /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0807-062-9502-1 Al-EX 16.04 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Berry 1/4: ,/'/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> L3-3‘t k,r.ia.—R.., 6 P'L -metre_ <br /> ❑Sanitary permits <br /> CSM: LOT i SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAlR REVIEW <br /> PROJECT DESCRIPTION: <br /> Storage Shed ❑ 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: ❑ Rural Address <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 14.0 1.0 ❑ VMetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosianCOntrol permit <br /> BASEMENT: 1ST FLOOR: 2,400.0 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> ♦ titling/access) <br /> 2ND FLOOR: 3RD FLOOR: 2,400.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST -i -.► i -► and available options. <br /> (Please round to nearest dollar) $ 20,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies no Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ON <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 Jon't know <br /> 7. Is this to correct a violation? ❑Yes ONO <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -- —► <br />