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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU TOMER TO PROVIDE <br /> OWNER NAME <br /> Jason Schlieckau <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 1! Zoning Status; CUP; <br /> W9202 D Ripley Road Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> (608)469-5680 (608)469-5680 jschliec@hotmail.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> self self 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> i1A� <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> PHONE PHONE 51 Site Plan royal from <br /> appli a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONIN : ACREAGE: 4 Elevation of property <br /> D PARCEL OCR 11�a �n �. O,135 .,O p H - I 2.84 frontage drawn to scale. <br /> NUMBER 1�! l.0 4 /� (� <br /> TOWNSHIP: SECTION: <br /> Christiana 20 1/4. x"+j4+/: �-KJ 0 Driveway permits „ -15 <br /> ADDyR�ESS: (state,county,town) <br /> L O Hwy B S- itary permits 1 •• , <br /> CSM: 11,876 LOT 1 SUBDIVISION BLOCK/LOT .ublic,private) V " <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTIOtr: , <br /> New home T �e c_ Q c C 13 oning District <br /> . 0 This project is a new building or structure. <br /> ILI Permitted Use? <br /> DThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: E " ral •ddress <br /> EWER EPTIC 137-201,500,398 (new -xisting) <br /> HEIGHT IN FEET f NUMBER OF STORIES: (Not induding basement) <br /> 29-8-- 1.0 ❑ Wetland/FI plain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shorela (attachment) <br /> (Outside dimensions including unfinished area,attached gars a;d above grade decks or porches) <br /> BASEMENT: iSTFLOOR: ) 7-6� �q es ErosionControl permit <br /> 2,768.0 ~� :� + TOTAL SQUARE FOOTAGE: 4, (Slopes,disturbance, <br /> y,2ND FLOOR: 3RD FLOOR: 711 /l.+5753E44 filling/access) <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 290,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ['No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes QVo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? res a jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ao <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) Dyes :No DDon't know <br /> 7. Is this to correct a violation? Dyes Dia <br /> 4 G �� APPLICATION MUST BE SIGNED <br /> 545-112(4/Oft) I (Continue on Back) ■ —► —0 <br />