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4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C TOMER TO PROVIDE <br /> OWNER NAME <br /> Jose Rojo <br /> OWNER ADDRESS (Number,Street.City.State.Zip) Vi Z ing Status; CUP; <br /> 5556 Surry Lane,Waunakee,WI 53597 D ed Restriction;CSM <br /> V r' nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)448-5077 solomio0415 @gmail.com ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd ncludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden Meigs Inc. Si Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of ell/septic <br /> 1527HWY14P.O.Box412 1527 Hwy 14 P.O.Box 412 <br /> (City,State.Zip) (City.State.Zip) etbacks <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> PHONE PHONE ❑ ite Plan pproval from <br /> (608) 767-2729 (608) 767-2729 lic le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.com loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑PARCEL 004/0807-124-8000-5 A-1(EX) 20.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • <br /> Berry 12 +/4. ,- %/4%/4 <br /> NE' . ❑Drivewa ermits <br /> ADDRESS: (state ounty,town) <br /> 5991 Whippoorwill Cross Plains, WI 53528 <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanita rmits <br /> (• bI'',private) <br /> PROPOSED PROJECT INFORMATION =TAFF REVIEW <br /> PROJECT DESCRIPTION. <br /> Run-In Shed#1 x 1 O 4•ning District <br /> . 151This project is a new building or structure. C 'ermitted Use? . <br /> ❑This project is an addition/ teration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBE� t, LI Rural • ••res <br /> EWER EPTIC (new/e istin• <br /> HEIGHT IN FEET: NUMBER OF STORI : (Not including basement) <br /> 8.9 1.0 ❑ Wetland/F laity <br /> AREA TO NEAREST SQUARE FOOT: Shore d (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> LI ErosionContt ermit <br /> BASEMENT 1ST FLOOR: 300.0 ,, TOTAL SQUARE FOOTAGE: j, n <br /> (slopes, urbae, <br /> 2ND FLOOR: 3RD FLOOR: ©o filling/ ess) <br /> ❑ Review Location Survey <br /> k6 <br /> ESTIMATED CONSTRUCTION COST: ♦ - - ♦ ♦ and available options. <br /> - <br /> (Please round to nearest dollar) $ 4,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ✓❑Jo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ❑'io <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ENO <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 EIJo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓No <br /> 4 , APPLICATION MUST BE SIGNED <br /> 7,0. (Continue on Back) ♦ -s <br /> 545-112(4/08) <br />