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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Jeff Rahn <br /> III Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,ZZp) Deed Restriction;CSM <br /> 2345 State Rd 73 Cambridge,WI 53523 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)332-0588 26jrahn @gmail.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n Site Plan including location <br /> AGENT ADDRESS <br /> CONTRACTOR ADDRESS of well/septic <br /> (City,State,ZiP) <br /> ('may,State Zip) ❑Setbacks 0 Site Plan approval from <br /> PHONE PHONE applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.usr) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation <br /> drawn property r scale. <br /> nPARCEL 016/061221184302 Al-Ex 0.98 <br /> NUMBER <br /> TOWNSHIP: SECTION: , ne Driveway permits <br /> Christiana 21,612 '/•: ne ' ` (state,county,town) <br /> ADDRESS_ 2345 State Rd 73 Cambridge, WI 53523 <br /> ❑Sanitary permits <br /> CSM: 4,�A LOT 1 SUBDIVISION BLOCKJLOT (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ❑ Zoning District addition and attached garage.Re-side and re-roof entire structure <br /> . rA This project is a new building or structure. ❑ Permitted Use? <br /> NI This project is an addition/alteration to an existing building or structure. ❑ Rural Address <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> (new/existing) <br /> EWER �EPTIC <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 16.5 1.0 ❑ Wetland/Floodplainl <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: ,5$$.0 1♦ TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> $�.� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 1,768.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: d� 86,000.00 and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Eyes alo lDon't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> nYeslo nDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes oN,,4�o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 0No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> leS �o QDon't know <br /> 6. Is a location survey required? (see reverse) u' <br /> 7. Is this to correct a violation? <br /> Yes 0No <br /> APPLICATION MUST BE SIGNED <br /> ` v f� (Continue on Back) -♦ —► —. <br /> 545-112(4106) i%')- �/ �J <br />