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Cad • bp <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOIIRR 0 PROVIDE <br /> OWNER NAME ••/r`/` 7 <br /> Yellow Dog Carolyn Ball <br /> Farmstead/ Jeff : ❑Zoning Statusl CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> W8976 County Road C, Fort Atkinson, WI 53538 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (608)423-9933 ' (608)213-9068 jeffball61 @gmail.com ❑Site Pla dra to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME CONTRA TOR NAME <br /> Jeff Ball El Site Ppcluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well eptic <br /> W8976 Conty Road C <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Fort Atkinson, WI, 53538 <br /> PHONE PHONE ❑Site PI a rom <br /> (608) 213-9068 applic I hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeffba1161@gmail.com ❑Floor plakK scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane-co.dane.wi.us/) El Elev to f property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑PARCEL 24/0712-244-9002-0 A-1 (EX) 35.00 fronta drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Deerfield 24,712 1/4. SW %1/. SE ❑Drivew r <br /> ADDRESS: (state, o ) <br /> 76 Fair Oak Road, Deerfield, WI <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sand Its ■ M. ri l <br /> 2,853 (p It, II , r ate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Pole barn w! 4 ' ► 7/ ❑ Zoning <br /> . 0 This project is a new building or structure. ❑ PermittecLlyse? <br /> ['This project is an addition/alteration to an existing building or structure. v <br /> SANITARY SERVICE: PERMIT NUMBER:^! ❑ Rural A!• ess <br /> !EWER PTIC / `�� (new/z- isti g) /,�� 6:4 <br /> HEIGHT IN FEET: NUMBER QF STORIES: (Not including basement) (/ VV <br /> t 1 1.0 ❑ Wetlan��;;F lain/ <br /> Shore��fr'�lchment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1STFLOOR:�IL� ❑ EtOSIO •���• •ermit <br /> TOTAL SQUARE FOOTAGE: + (slope- , 7's twice, <br /> (4 filling/ cress) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ❑ Review , urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ b and ava -• :/•••'OnS. <br /> (Please round to nearest dollar) () <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ISINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes ✓No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Es No <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) Des ❑No ['Don't know <br /> 7. Is this to correct a violation? Elves ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> 545-112(4/08) <br />