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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> owNER NAME Justin J Harkins <br /> Ce i El Zoning Status;CUP; <br /> O44 A nRooSt,( ta A, ty,State,Zip) <br /> Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 941-391-3525 justin.harkins @gmail.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> Ny�IT��{{ NAME C� V/�RACTOR NAME <br /> N/ J Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of <br /> property CURRENT WING: <br /> ❑PARCEL PAWZR-1 01 2-0 AC y : <br /> frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SEC <br /> • Middleton 1/4: NE Y.4/4: NE Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4486 Shooting Star Ave <br /> S IVISION BL CK/LOT ❑Sanitary permits <br /> CSM: LOT ri,Q fie i `g2 (public,private) <br /> • <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> P OJECT DESCRIPT ON: <br /> Site a portable domestic fowl enclosure in the rear yard of residence ❑ Zoning District <br /> . his project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: �/ PERMIT NUMBER: El Rural Address <br /> EWER /I�[GEPTIC (new/existing) <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) <br /> ik ❑ Wetland/Fioodplain/ <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:r ❑ ErosionControl permit <br /> 6 + TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: l���J filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ 300 and available options. <br /> (Please round to nearest dollar) S <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ea No EDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes ,/No 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? laes 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) QYes IN No Don't know <br /> 7. Is this to correct a violation? Elves SI No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />