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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 /> Matthew and Dawn Gramse <br /> 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 304 Bellrose St.,Belleville,WI 53508 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)424-1334 (608)333-7572 mgramse @yahoo.com <br /> Site Plan drawn to scale <br /> AGENT INFORMATION 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.wLus/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 040/0508-342-2344-2 f .•' . 0.50 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Montrose 34 %/4: NW 1/1/4. NW ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> 304 Bellrose St. <br /> El Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 14 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Addition of 80 sq ft.to current deck . ❑ Zoning District <br /> . OThis project is a new building or structure. <br /> ❑ Permitted Use? <br /> IS This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER [)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> 1 TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 224.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: available <br /> (Please round to nearest dollar) ♦ ♦ -4 ♦ ♦ ♦ $ 3,500.00 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes INNo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EINo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes FNo <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 ONo ODon't know <br /> 7. Is this to correct a violation? ['Yes rNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -* <br /> 545-112(4/08) <br />