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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 /> Third Door LLC <br /> ONERADDRESS (Number,Street,City,State,Zip) Zoning Status; CUP; <br /> W <br /> Deed Restriction; CSM <br /> 1523 State Highway 78,Mt Horeb WI 53572 Variance(# ) 97/7 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)4374840 <br /> 15I Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME 14;'(A4 a <br /> Andy Mlsna <br /> Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> same <br /> (City,State,Zip) (City,State,Zip) al Setbacks 24:2(. <br /> ��� <br /> PHONE PHONE 51 pproval from <br /> Site Plan approval <br /> 212-0750 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> misnacustomhomes @yahoo.com Floor plans to scj Ve/s <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 property <br /> ❑PARCEL 0606-221-8085-0 C-2 3.19 frontage drawn t <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Blue Mounds 22 1/4: NE x1h: NE Dr' way pe <br /> ADDRESS: al court town) <br /> 10043 Blessingway Road <br /> Sani vat <br /> csm: 10,980 LOT 3 SUBDIVISION BLOCK/LOT (publi lk rivate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 8'x 4'x 8'dev sign Zoning District <br /> . This project is a new building or structure. Permitted Use? 0 e :/ <br /> ['This project is an addition/alteration to an existing building or structure. Si ` <br /> SANITARY SERVICE: PERMIT NUMBER: ilf Rural ;,,,,..�- -�- , <br /> EWER [EPTIC (ne iiii �r <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 8.0 1.0 Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) t Vol- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> Eropesndintrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 32.0 j TOTAL SQUARE FOOTAGE: + (slopes,disturbance, N let <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 32.0 <br /> "'A Review Location Survey / <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —' —° ♦ ♦ and available options. IV� <br /> (Please round to nearest dollar) $ 500.00 <br /> t° -K <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes QNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes Elo (Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ r'es IJVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes EINo <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 OW ['Don't know <br /> 7. Is this to correct a violation? ['Yes UNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />