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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU'.TOMER TO PROVIDE <br /> OWNER NAME <br /> Paul and Dayna Dreis <br /> OWNER ADDRESS (Number,Street.City.State.Zip) I1 zo ' g Status; CUP; <br /> 5455 Mahocker Rd. Mazomanie,WI 53560 D d Restriction;CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS V riance(# ) <br /> (608)795-4986 paul.dreis @strand.com to Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden Meigs Inc.-Dave Budden ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> P.O.Box 412 P.O.Box 412 <br /> (City,State,Zip) (City,State.Zip) ❑Setba ks <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> PHONE PHONE ❑Sit Ian proval from <br /> (608) 767-2729 (608) 767-2729 a lic le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.com loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑PARCEL 006/0806-194-8170-8 A-1(EX) 13.00 frontage draw scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Black Earth 19 1y4: SE 1/41/4: NE ❑Drive y permits <br /> ADDRESS: (s e, county,to n) <br /> 5455 Mahocker Rd. Mazomanie, WI 53560 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanita •ermits <br /> (pi ,private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Garage (91-1 111 I ■ •Wing District <br /> . FThis project is a new buildin r structure. • Permitted Use? <br /> ❑This project is an addition/ teration to an existing building or struct re. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rura S <br /> EWER EPTIC \ (new <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not indu mg basement) <br /> 14.3 1.0 ❑ Wetland/F plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore) (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionContro unit <br /> BASEMENT 1ST FLOOR: <br /> 960.0 ,, TOTAL SQUARE FOOTAGE: , (slopes,di rbance, <br /> filling/ ss) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 960.0 ❑ Review Location Surveyf 1rn' \ <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> \ 1 <br /> (Please round to nearest dollar) -* --P '- $ 45,000.00 ���JJJ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes a"Jo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes 1/❑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) Dyes No ❑Don't know <br /> 7. Is this to correct a violation? Eyes ✓❑No <br /> APPLICATION MUST BE SIGNED <br /> 54.5-112(4/08) <br /> (.01-) % <br /> (---- (Continue on Back) - -+ -► <br />