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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 /> Karen E. Kessenich <br /> r2 Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3969 Dvorak Rd., Deerfield,WI 53531 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)512-9803 (608)512-9803 karen @inlandboatworks.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Karen E. Kessenich Karen E. Kessenich <br /> Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3969 Dvorak Rd. 3969 Dvorak Rd. <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> Deerfield,WI 53531 Deerfield,WI 53531 <br /> PHONE PHONE 0 Site Plan approval from <br /> (608) 512-9803 (608) 512-9803 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> karen @inlandboatworks.com karen @inlandboatworks.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> 0 NU BER O 3-a-/g3- ()0o0-3 z-- C - 1.. g , a,3 j frontage drawn cafe. <br /> TOWNSHIP: SECTION: <br /> Deerfield / ' 1/4: S V4J 1/4'/4: S V j ❑Driveway rmits <br /> ADDRESS: (state unt wn) <br /> 3969 Dvorak Rd. <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanita permits <br /> 13 0 3 i pu c,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: rn <br /> New Shop/Service Buil.ding ` j i )( C) V, oning District <br /> . MI This project is a new building or structure. ermitted -- <br /> ❑This project is an addition/ eration to an existing building r ructure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ raI A.ire <br /> EWER EPTIC ew/e■ tin! <br /> HEIGHT IN FEET: NUMBER OF STORIES: of i cluding basement) o `� N <br /> 14.0 1.0 Wetiand/Floodplain/ t r \ <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: ❑ ErosionControl permit <br /> 0.0 <br /> 4,000.0 4, TOTAL SQUARE FOOTAGE: 1, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0.0 0.0 <br /> 4,000.0 ❑ Review Location Survey _p C•ESTIMATED CONSTRUCTION COST: ♦ -► $ /. and available options. l� <br /> (Please round to nearest dollar) $ C a/10 u d !� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Jo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑✓Yes ENo ❑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? ❑✓Y DNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I ve blank if none) <br /> 6. Is a location survey required? (see reverse) es ✓"lo ['Don't know <br /> 7. Is this to correct a violation? EYes 'lo <br /> APPLICATION MUST BE SIGNED <br /> (9,0 ' i-' it...41.APPLICATION O o....S.T <br />