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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Allen Gierhart & Rachael Knickmeier <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSIV , <br /> 115 Swift St.Apt#5, Edgerton, WI 53534 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)214-3194 gierharta @gmail.com ❑Site Plan dr wn to e <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and include ' ensions <br /> AGENT NAME CONTRACTOR NAME <br /> Integra Construction-Dave Klossner ❑Site Plan' cl g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se <br /> N6006 River Road <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Monticello, WI 53570 <br /> PHONE PHONE ❑Site��` I from <br /> (608) 214-0995 appil t wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> klossner @tds.net ❑Floor plan to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dare.v,!.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: Y' D. ..Tv E: ❑Elevatioproperty <br /> ❑PARCEL 0512-052-8835-0 RH-1 tU 2.29 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Albion 5 '/4: NW 1/41 4: NW ❑Dri w permits <br /> ADDRE Cty HWY W Stoughton, WI 53589 (stat coun town) <br /> 1M: LOT , BLOCK/LOT ❑S a n i ry ermits 1� <br /> 14,183 (publi rivate) 3 ( (IV\ <br /> PROPOSED PROJECT INFORMATIONS <br /> PROJECT DESCRIPTION: <br /> Construction of new single family residents {: Zoni » :_' �to'e <br /> Q This project is a new building or structure. Ca Pen se <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 ttrral °t•ress <br /> EWER [EPTIC 1 3,201,600,067 ,-;+y EI <br /> H GHT IN FEET ✓ NUMBER OF STORIES: (Not including basement) <br /> 11' 1.0 met ,a, ,..plain/ <br /> AREA TO NEARS T SQUARE FOOT: Sho t1achment) <br /> (Outsi dimensions including uunfinished area ached garages and above grade decks or porches) <br /> BASEMENT: _/ 1ST FLOC) ry(Slopes 2,053.0 �r 3,577.0 + TOTAL SQUARE FOOTAGE: j slop disturbance a +'fir <br /> 2ND FLOOR: 3RD FLOOR: filling/access) vo t c 5,630.0 <br /> ESTIMATED CONSTRUCTION COST: Ftevl . p• 'SUrve�y� <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ -► $ 310,000.00 and �eplOr1S. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 'lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ✓❑fNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑✓Yes D'lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EN <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 r✓"lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓❑No <br /> ACA UST BD <br /> 545-112(4/08) (Continue PPLI on TION BacMk) -�E SIGNED—.. <br />