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1 <br /> ;... <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> Jose Rojo Zoning Status; CUP; <br /> OWNER ADDRESS (Number.Street.City.State.Zip) <br /> Deed Restriction; CSM <br /> 5556 Surry Lane,Waunakee,WI 53597 <br /> Variance(# ) <br /> HOME PHONE <br /> I CELL PHONE E-MAIL ADDRESS <br /> ` (608)448-5077 solomio0415 @gmail.com ,Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden Meigs Inc. to Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS If well/septic <br /> 1527 HWY 14 P.O.Box 412 1527 Hwy 14 P.O.Box 412 <br /> (City.State.Zip) (City.State,Zip) Setbacks <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> PHONE PHONE ❑S.e Plana royal from <br /> (608) 767-2729 (608) 767-2729 appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.com IOor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) kievation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 004/0807-124-8000-5 A-1(EX) 20.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: /%J <br /> Berry 12 1/4: € %4'/4: -V ❑Drivewa ermits <br /> ADDRESS: (stat ,county,town) <br /> 5991 Whippoorwill Cross Plains, WI 53528 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary .ermits <br /> (publi•, private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Run-In Shed#2 0 '( C Z ing District <br /> This project is a new building or structure. ❑ ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structur . <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural dres <br /> EWER EPTIC Yi (new/ isting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 8.9 1.0 ❑ Wetland/F dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore) d (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1---b ErosionCo of permit <br /> 300.0 4 TOTAL SQUARE FOOTAGE: + (slopes, sturbance, <br /> © 0 filling/ ess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review Location Survey 1\,C <br /> ESTIMATED CONSTRUCTION COST: and available O tions. <br /> (Please round to nearest dollar) $ 4,000.00 p <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 to ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Elo <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) Elves alo ❑Don't know <br /> 7. Is this to correct a violation? Elves ✓�lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 702, 6 ° (Continue on Back) -+ ♦ -+ <br />