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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIOE <br /> OWNER NAME <br /> Silas Zirn & Michele Bitter Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM 3 3 G 3 <br /> 5644 Willoughby Rd.Mazomanie,WI 53560 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (608)628-0730 (608)628-0730 silas.zim @gmail.com Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR�N'4^"E M , / <br /> ;SON t- I A-5TQN M Site P --writ .ding location 2 <br /> AGENT ADDRESS CONTRACTOR ADDRESS_ -II/septic <br /> 1l9 <br /> AV <br /> (City,State,Zip) City,State,Zip) 0 Setbacks 3 OA)A-Q <br /> Yacc co 1k71 S37/3 <br /> PHONE pON1 7)234/-3 ,46 Site Plan approval from <br /> lGL7�. applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS /� <br /> 5MSOJUS6e H©TMAIL,L1°� l Oro Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT P RCEL//NUMBER: CUR- T ONING: ACREAGE // Elevation of property <br /> ❑ <br /> NUMBER � ©�L/�/� _��So^�I ! /V, l 6' frontage drawn to scale. <br /> TOWNSHIP: SECTI N: c <br /> Town of Mazomanie 7T 1/a: %IAA: S E IN Driveway permi _ <br /> ADDRESS: (state,count to • <br /> 5644 Willoughby Rd. Mazomanie WI 53560 <br /> CSM: LOT SUBDIVISION BLOCK/LOT 1e1 Sanitary �� its <br /> (publi private' <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / / <br /> 42'x64'engineered steel storage building Ail Zoning District 47 n <br /> . OThis project is a new building or structure. fr Permitted Use <br /> 33C 3 <br /> ❑This project is an addition/alteration to an existing building or structure. "S cf ois '4. td <br /> SANITARY SERVICE: PERMIT NUMBER: Art Rurat a?!• G.r)EWER [EPTIC � ' ' . 4 i^ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,/ Wetland/Floodpiaini <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: �-/ �Sto��on permit <br /> 2 (/ 4, TOTAL SQUARE FOOTAGE: + (stOpes;;t disturbance <br /> 2ND FLOOR: 3RD FLOOR: ���000 DDD <br /> filling/access)) <br /> ESTIMATED CONSTRUCTION COST: /t. and Review Location_s e �k <br /> (Please round to nearest dollar) <br /> "� "� ♦ ♦ "♦ ♦ �� ©D 0 and aVaEtat3t�3rts <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes INNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes allo ['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? Efres MINo <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 151No ['Don't know <br /> 7. Is this to correct a violation? ['Yes MIN <br /> 2 ../, tP 0 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i -► <br />