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1_f ---1 51 . c-f 0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Turkey Road Farm LLC/Bridget Handel <br /> ❑Zoning Status; P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re trl On; CSM <br /> c/o Foley&Lardner P.O.Box 1497,Madison,WI 53701-1497/9440 Blackberry Rd Black Earth,WI 53515 <br /> Variance( ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)767-3137 (608)286-9150 bhandel @tds.net ❑Site Plan n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> William Keuler/Keuler Construction Keuler Construction, Inc. ❑Site Plan iptluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ tic <br /> 8308 State Road 19 8308 State Road 19 <br /> (City,State,Zip) (City,State,Zip) ❑Setbpcl <br /> Cross Plains, WI 53528 Cross Plains, WI 53528 �/ <br /> PHONE PHONE ❑Site Plan .••Atal from <br /> (608) 798-1771 (608) 798-1771 applicab 4 '. n+ hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS � <br /> keulerconstruction @hotmail.com keulerconstruction @hotmail.com El Floor plt:tns to scale <br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.us/) <br /> PARENT❑PARENT PARCEL NUMBER: CURRE NZO ING: ACREAGE: ❑Elev.t'..n of property <br /> (1 + • :j 0 0 ' o8 fronta.e draws • <br /> NUMBER _ - <br /> TOWNSHIP: SECTION: <br /> Town of q i o Berry '/a: Y'/4: " '14 ADDRESS: a +4,r .- <br /> CSM: LOT `I 5176 IVI ON BLOCK/LOT ❑unitary fer S <br /> 14,113 (public, i te) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> CONSTRUCTION OF NEW SINGLE FAMILY HOME ❑ Zoningtnct <br /> 0 This project is a new building or structure. ❑ Perrnfed Uses <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC 13-,aoi E -W i /existing) <br /> HEIGHT IN FEET: \ i NUMBER OF STORIES: (Not including basement) <br /> 'V/ ('k EAR ❑ Wetlan I�dplain/ <br /> AREA TO N EST SQUARE FOOT: <br /> Shoreldnid (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ,,,�„swat, - <br /> BASEMENT: 1ST FLOOR: <br /> 3 C3 S pti g9 4, TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR. 0 3RD FLOOR: �� l t ��::a{g <br /> ❑ L tton u y <br /> ESTIMATED CONSTRUCTION COST: -► ♦ --► ♦ ♦ [J G co �ailable options. <br /> (Please round to nearest dollar) y 7 �� g <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑1'es ✓❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ✓JNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓Yes f to <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 ❑No ['Don't know <br /> 7. Is this to correct a violation? ❑1'es ❑✓No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aloe (Continue on Back) —► -4 -♦ <br /> G pnrm ( -j- <br />