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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Henry Land LLC <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status;CUP; <br /> 7794 Patton Rd., Dane, WI 53529 Deed Restriction; CSM <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> (608) 846-4112 (608) 575-1727 joe @henryfarmsllc.com <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Bonntrager Const. [l Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> W2432 Cty E <br /> (City.State,Zip) (City,State,Zip) 0 Setbacks <br /> Cambria,WI 53923 <br /> PHONE PHONE ❑Site Plan approval from <br /> (920) 296-6068 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:I/accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> 0 PARCEL 0909-033-8500-4 <br /> NUMBER A-1-Ex ;A-B 40.00 frontage drawn to scale. <br /> TOWNSHIP: SECTION! <br /> Vienna 3 %: NW %,/4: SW [] Driveway permits <br /> ADDRESS. 7794 Patton Rd.,Dane, WI 53529 (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> Agricultural shed <br /> 0 Zoning District <br /> • 12 This project is a new building or structure. <br /> 0 <br /> ❑This project is an addition/alteration to an existing building or structure. Permitted Use? <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER f EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 22.0 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore land (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1STFLOOR: ❑ ErosionControl permit <br /> 1,600.0 ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: fllling/aCCeSS) <br /> ESTIMATED CONSTRUCTION COST: Li Review Location Survey <br /> (Please round to nearest dollar) -► -+ -► -► -► -► $ ' and available Options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓JNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ✓ o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q Yes o <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# <br /> (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ['Yes ✓f'Jo ['Don't know <br /> 7. Is this to correct a violation? <br /> QYes ✓ON° <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ♦ -♦ -.► <br />