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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAM E <br /> Phillip Marx <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7772 Inama Road,Sauk City,WI 53578 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (608)643-2799 <br /> ISI Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Mike Bisbach,Jewell Associates Engineers,Inc. Building-Wick Buildings 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 560 Sunrise Drive 405 Walter Road <br /> (City,State,Zip I (City,State,Zip) 51 Setbacks <br /> Spring Green,WI 53588 Mazomanie,WI 53560 <br /> PHONE PHONE <br /> ❑Site Plan approval from <br /> (608) 588-7484 (608) 795-2534 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mike.bisbach @jewellassoc.com buildings @wickbuildings.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: oproperty <br /> 0 PARCEL 0907-054-8500-3 AG 40.30 frontage drawn to scale. <br /> NUMBEF( <br /> TOWNSHIP: SECTION: <br /> Roxbury 5 1/4: SE %I/4: NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 7772 Inama Road, Sauk City, WI 53578 <br /> MI <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Building a snail Ag building with a bathroom. ❑ Zoning District <br /> MI This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> DEWER )EPTIC 13,201,500,154 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 8.3 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dirrensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 0.0 1ST FLOOR: 320.0 <br /> 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> ♦ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 320.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available O tions. <br /> (Please round to nearest dollar) ♦ ♦ -� ♦ $ 13,875.00 p <br /> 1. The proper)is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes Dlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Ilo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a locaton survey required? (see reverse) ❑Yes ao ❑Don't know <br /> 7. Is this to -correct a violation? Dies ao <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) <br />