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ZONING PERMIT APPUCATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Robin Pharo <br /> _ AQoR ry r s �t zJ� 0 Zoning Status;CUP; <br /> 853 UUerSi Valle HQ M e i) Deed Restriction;CSM <br /> y oun Horeb, W 1 53572 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-832-6889 608-513-5617 robinp @tds.net ©Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME RACq�N <br /> eileafy T t it Ing 2 Site Plan including location <br /> AGENT ADDRESS ESS of well/septic <br /> 11 0aoll treet <br /> (City,State,Zip) State,Zip ©Setbacks <br /> Verona,)WI 53593 <br /> PHONE PHONE 0 Site Plan approval from <br /> 800-373-5550 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PAR CURRENT ZONING: AC A 0 Elevation of property <br /> ❑PARCEL � "-' 1-8060-0 A-1 2b.�3E93 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT : <br /> Springdale IA: 'WA: ['Driveway permits <br /> ADDRESS: 1853 Duerst Valley Rd, Mount Horeb, WI 53572 (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> ❑Sanitary permits <br /> 13061 2 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New agricultural out building ❑ Zoning District <br /> . Q✓This project is a new building or structure. <br /> ❑ Pem>i<ttea Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> DEWER EFEPTIC (new/existing) <br /> HEIGHT IN FEET: 13� 4" NUMBER OF STORIES: (Not including basement) <br /> 1 ❑ 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) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 2304 + TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filing/access) <br /> 2304 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 60,000 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? IJ(es Oslo D)on't know <br /> 2. Is there a wetland or floodplain on or near the property? Des �/ o D)on't know <br /> 3. Have you talked with the township about your project and are they in agreement? e)(eslo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? laes DVo <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) Des o [J)on't know <br /> 7. Is this to correct a violation? Yes o <br /> APPUCATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />