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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 /> Adam and Kara Burkhalter <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 9225 Fargo Rd, Mount Horeb, WI 53572 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (608)354-5929 I (608)354-5929 adamlburkhalter @hotmail.com 12 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> N/A N/A IN Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) CS Setbacks <br /> PHONE PHONE 0 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http://accessdane.co.dane.wi.usl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 71 Elevation of property <br /> ❑PARCEL 054/0607-292-8700-9 A-1 11.80 , frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Sprindale 1,967 1/4: 2067 1/41/4: 2967 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9225 Fargo Rd <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 5,839 3 (public,private) �� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION. f <br /> New deck on rear of house �J Zoning District <br /> . 0 This project is a new building or structure. Ltd"Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: S2<Ural '•• s <br /> EWER )*EPTIC (ne existln! <br /> HEIGHT IN FEE NUMBER OF STORIES: (Not including basement) <br /> 2.0 1.0 'Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> ErosionControl permit <br /> 644.0 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR 3RD Fl OOR. <br /> 644.0 <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ '- ♦ -+ -' 5 5,000.00 <br /> nd available options. <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? DYes ONo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes No Don't know <br /> 3. Have y ' h t wnshi about your project and are they in agreement'? Q Yes LJNo <br /> 4. Has the t z for this property in the past 5 years? Q✓Yes ONo <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) QYes 12 No DDon't know <br /> 7. Is this to correfipRriotalpn2016 [Yes 12 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -4 <br /> 545-10I410@1 COUNTY PLANNING <br />