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s <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jeff Huber <br /> ['Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City.State,Zip) Deed Restriction; CSM <br /> 5712 Enchanted Valley Rd Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)798-1405 i (608)712-4634 mr3putt@tds.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeff Huber ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE n 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.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL 0807-133-8650-8 2.10 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Berry 13 1/4: NW /1/: SW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 5712 Enchanted Valley Rd <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . IN This 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: ❑ Rural Address <br /> EWER r)EPTIC '(new/existing) <br /> HEIGijT IN FEET: r NUMBER OF STORIES: (Not including basement) <br /> G� ��J 16.0 1.o ❑ Wetland/Floodplain/ <br /> J 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: ❑ <br /> ErosionControl permit <br /> 600.0 4, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 600.0 <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —• -+ ♦♦ and available options. <br /> (Please round to nearest dollar) $ 8,200.00 <br /> 1. The property is within 300 feet of a stream or 10 0 feet from a pond or lake? ❑Yes ✓�lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the pro erty? ❑Yes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes rL�Jlvo <br /> 4. Has there been a zoning permit issued for this pr perty in the past 5 years? Dies ❑✓No <br /> 5. Is this project associated with a rezone/CUP/vari nce(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ,KlYes No ['Don't know <br /> 7. Is this to correct a violation? Wes ✓❑hlo <br /> 9 e S La ]T <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ -+ <br /> 545-112(4/08) <br />