Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Justin Johnson <br /> 0 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 6382 Old Settlers Road Mazomanie WI 53560 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)767-2919 (608)209-1238 jtj6969 @sbcglobal.net Q Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Q Setbacks <br /> PHONE PHONE Q Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRE T ZONING: ACREAGE: Ei <br /> Q PARCEL 004/0807-052-8100-1 A1-(EX) 5.84 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Berry 5 1/4: NE 1/1/4: NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 6382 Old Settlers Rd Mazomanie WI 53560 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 3,300 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 100 Sq ft Deck addition a Zoning District <br /> . QThis project is a new building or structure. Permitted Use? <br /> ISIThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 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) ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 1, 4, TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ' filling/access) <br /> . Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: oC�S�� and 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? QYes E io QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes E o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓Q Yes EJNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ao <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 ✓ Jo QDon't know <br /> 7. Is this to correct a violation? QYes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -► -► <br />