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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App a <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER JOLEEN WESTPHAL <br /> Zoning Status;CUP; 1 4, ,/ <br /> OWNER ADDRESS (Number,Bred,CIty,State,BP) <br /> Restriction;CS 7 <br /> 1 mg LOMPRINGFIELD ROAD, LODI, WI OW van:n� / <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (609)712-0159 joleenw6@yahoo.com , iii Site Plan drawn to scale i <br /> AGENT INFORMATION CONTRACTOR INFORMATION y and includes dimensions 0 i <br /> AGENT CONTRACTOR NAME <br /> Jeremy%trebel BIN Giese R <br /> r= :. � Site Plan including location <br /> igiir Tr •• Tie- :. .1 - : :..1 <br /> 6497 HICKORY LANE W12032 County Rd W <br /> (City,sr e,2W (city.Slue,w) I Setbacks (F ��F° — , <br /> WAUNAKEE,WI 53597 Baraboo,WI 53913 T ,5. <br /> PHONE PHONE lasite Plan approval from 4 <br /> (608) 212-4285 (608) 393-4893 applicable township. <br /> E-MAIL ADDRESS E-MALADDRESS <br /> jeremystrebel©gmail.com :'/ Floor plans to scale 4/...e <br /> PROPERTY LOCATION INFORMATION (http: accessdane.co.dane.wi.us ) IeValbrtofproperty � <br /> 0 022/0908-202-8560-0 RH-3 11.45 frontage drawn to sea . 0.e l <br /> TOWNSHIP: SECTION: <br /> DANE 20 %: NW WA: NW fiDnvewaY pew'" <br /> sitivo- <br /> ... own <br /> 7165 LODI SPRINGFIELD ROAD, LODI WI 53555 1 ? <br /> ten . •... <br /> csM: 12,164 LOT 1 N//SUBDIVISION eLOCIULOT , per.,. , <br /> PROPOSED PROJECT INFORMATION STAFFRIVINW <br /> PROJECT DESCRIPTION: <br /> N ONTO n I� ' c a -/+7 (2-- 3 <br /> ADDITION ONTO EXISTING HOUSE , PMT' zoning Al - F <br /> . QThis project is a new building or structure. L`at �to. e I' i Pied Use? - dot_ S r <br /> MI This project is an addition/alteration to an existing building or structu/e. <br /> SANITARY SERVICE: PERMIT NUMBER afRural . 7 J <br /> ( ■``�wil� TQ© <br /> HEIGHT IN Fi=ET. NUMBER OF STORES: (Not rlidrp basement) <br /> 29.0 2.0 <br /> �iili�iii � <br /> AREA TO NEAREST SQUARE FOOT: attachmant) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) C/) <br /> �E <br /> BAS rosionC'.ontrol <br /> BASEMENT 1ST ST FLOOR:0.0 910.0 4 TOTAL SQUARE FOOTAGE 4 (slopes, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 910.0 0.0 1,820.0 ReviawLocation Survey A71)Th <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ —' ♦ ♦ stud available opt <br /> (Please round to nearest dollar) $ 80,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ✓( o QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ✓ o QDon't know <br /> 3. Have you talced with the township about your project and are they In agreement? QYes ✓ lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYee [lo <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) QYes E2 ' QDon't know <br /> 7. Is this to correct a violation? .. QYes Q ' <br /> APPLICATION MUST SE SIGNED <br /> 545.112(WO (Continue on Sack) -, — -► <br />