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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 /> Nathan Lyle <br /> OWNER ADDRESS (Number,Street City,State,Zlp) ❑Zoning Status; CUP; <br /> Deed <br /> 2304 Carpenter Swain Road,Cambridge,WI 53523 Variance Restriction; CSM <br /> nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)215-9750 nathanJyle23 @gmail.com r Site Plan drawn to scale <br /> AGENT INFORMATION f CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Nathan Lyle 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 504 N Main Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Fort Atkinson,WI 53538 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 215-9750 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> lyle.constructionwi @gmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.eo.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE <br /> 0 PARCEL 016/0612-232-9660-0 Al /1-Z, 3.02 frontage drawn to scale. <br /> NUMBER _ <br /> TOWNSHIP: SECTION: <br /> Christiana 23 1/4: NW %�/4: SE 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2304 Carpenter Swain Road <br /> cSM 13,950 LOT 1 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 7x14 2nd story addition ❑ Zoning District <br /> . ['This project is a new building or structure. ❑ Permitted Use? <br /> tg This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address <br /> EWER P/ EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 21.0 2.0 Li Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Q <br /> ErosionControl permit <br /> 11242.0 4 9 ' ; TOTAL SQUARE FOOTAGE: ,1, (slopes,disturbance, <br /> `+_ filling/access) <br /> 2ND FLOOR:898.0 cfi 3RD FLOOR: r2,24Q.0 /1 <br /> 898.0 1/V� Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) '-r ♦ $ 6,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ao ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes ✓ o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Q✓Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? cc ❑Yes �io <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#/D-78..S ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) QYes ✓�io ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓ato <br /> APPLICATION MUST BE SIGNED <br /> _" (Continue on Back) -4. -4. -► <br /> 545-112(4/08) <br /> q ,Lio <br /> vi.,.., , <br />