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ill <br /> • ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> William or Cindy Beuthin <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 0 Zoning Status;CUP; <br /> 10129 East Mathewson Road,Mazomanie,WI 53560 Deed Restriction;CSM <br /> • Variance(# 10'047 ) <br /> HOME PHONE •CELL PHONE E-MAIL ADDRESS <br /> • (608)220-3844 cbeuthin @gmail.com ig Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions V <br /> AGENT NAME CONTRACTOR NAME <br /> Jake Holler ,C-:onera±i4-\3&,,i\cker� ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> "70 <br /> Ile <br /> c ?min'e.LosLt, <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> le <br /> '(`n2C1.0040JJ.12..W1 535(c0 <br /> PHONE PHONE 0 Site Plan approval from <br /> ( U$ obi`'. ,A$'9 applicable township. boy <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> FA Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.cadane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> 0 <br /> SO <br /> PARCEL 034/0806-033-9030-9 RH-1 2.04 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Mazomanie 1/4: i.,,.3 1/41/a: 5to6 0 Driveway permits le <br /> 03 s . (state,count t. i • <br /> ? East Mathewson Road <br /> M: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 1 2,764 2 r1 (public,private) <br /> PROPOSED PROJECT INFORMATION c�[ - - <br /> PROJECT DESCRIPTION: • <br /> new construction 5f-1 • Zoning District <br /> 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: LI r -1 Address <br /> EWER {EPTIC iiii existing) • <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 1.0 ❑ ''etland/Floodplain/ <br /> Shoreland (attachment) <br /> R TO NE EST SQUARE FOOT: <br /> Out ide dimensions inc ding unfinished area, ttached garage a a ve grade decks or porches) <br /> 1ST FLOOR: ❑ Eropes,di ntrol permit <br /> OTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> Iling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 g ) <br /> J Review Location Surve <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ -' ♦ ♦ - ♦ $ 235,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes jNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes MINo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes ONo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 10,047 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dyes DNo DDon't know <br /> 7. Is this to correct a violation? Dyes NINo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(8/09) <br /> (Continue on Back) ■ - <br />