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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Casey and Krista Lund <br /> 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 718 Hubert St,Edgerton,WI 53534 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)449-6531 lundcasey @yahoo.com <br /> Q Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> N/A Bernard Carley <br /> la Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 238 Goede Rd <br /> (City,State,Zip) (City,State,Zip) IN Setbacks <br /> Edgerton,WI,53534 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 884-9085 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING- ACREAGE: 0 Elevation of property <br /> ❑PARCEL 0512-033-9280-0 A-2(a 1 2.00 frontage drawn to scale. <br /> NUMBER J <br /> TOWNSHIP: SECTION: <br /> • Albion 3 1/4. SW %1/4. SW <br /> Driveway permits <br /> ADDRESS: (state, county,town) <br /> 786 Aarback Rd, Edgerton, WI 53534 Sanitary LOT SUBDIVISION BLOCK/LOT <br /> permits <br /> 12,800 1 N/A (public,private) <br /> PROPOSED PROJECT INFORMATION AFFREVIEW <br /> PROJECT DESCRIPTION: / N Single family residence 1.,\I / r'c n ' Rec,,r- o f'C ci- A ec _ ►! `ping District <br /> . IN This project is a new building or structure. 11, `, , <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural ` •• s <br /> HEWER [EPTIC /3 - 205 ©v3y Z (new 'xtst ?) <br /> HEIGHT IN FEET \ NUMBER OF STORIES: (Not including basement) <br /> 1.0 ❑ Wetl- 0 . ••plain! <br /> AREA TO NEAREST SQUARE FOOT: <br /> Sit•. - ' (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ rOS al permit <br /> BASEMENT 1ST FLOOR: lx <br /> '1.-1 2 5)n + TOTAL SQUARE FOOTAGE: 1 (ail ,d1�StUrt381'1 , <br /> (�' fit giaccess) <br /> 2ND FLOOR: 3RD FLOOR: 5.7 <br /> ❑ Review Location Su <br /> ESTIMATED CONSTRUCTION COST: / and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ -� ♦ ♦ Z6 / c/c" <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ElfVo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes IVo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes Dlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EIVo <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 ow ❑Don't know <br /> 7. Is this to correct a violation? [Yes OJo <br /> sa545-112 �� APPLICATION MUST BE SIGNED <br /> �g CO---- <br /> (Continue on Back) -► ♦ -i <br /> ttz laioai <br />