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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 /> Barbera Hale ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 9224 Fargo Rd Mount Horeb WI 53572 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (606) 832-6341 <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dennis Dignan Badger Home Improvement ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 144 Glen View Rd 144 Glen View Rd <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Mount Horeb WI 53572 Mount Horeb WI <br /> PHONE (608) 437-5698 PHONE (608) 437-5698 ❑applicable approval from <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dennis©badgerhomeimprovement.com ❑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 060729286000 A-1 11.75 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Sprindale 19 %4; SE %1h: SE ❑Driveway permits <br /> ADDRESS: 9224 Fargo RD Mount Horeb (state,county,town) <br /> ['Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 5,839 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Porch Addition w 1 .s-t , t rt.5 ❑ Zoning District <br /> . <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> 13 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 /> 17.0 1.0 ❑ Wettand/Ftoodplain/ <br /> Shoretand (attachment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> .,ErosionControl permit <br /> BASEMENT 1ST FLOOR ❑ <br /> : disturbance, <br /> -t I 0 + TOTAL SQUARE FOOTAGE 4, (slopes, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: (q 0 <br /> ESTIMATED CONSTRUCTION COST: $ ❑ ReviewLocatonSurvey <br /> (Please round to nearest dollar) '♦ ♦ "♦ ♦ ♦ $ 30,O®O a d ava ble Options. <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 go ❑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 ❑No <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 ❑Don't know <br /> 7. Is this to correct a violation? ['Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />