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�' ♦ Y/ ■ <br /> ZONING PERMIT APPLICATION Www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Benjamin Eustice <br /> '` ❑Zoning Status; CUP; <br /> r t -- 'DRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 4 : Schneider Dr. Oregon,WI,53575 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)835-0573 (608)215-7523 eusticesolutions @gmail.com Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> same same <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State.Zip) (City,State.Zip) ❑Setbacks <br /> PHONE PHONE 0 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/) 1=I Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL 028/0610-302-9580-3 Al 6.97 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP SECTION: <br /> Town of Dunn 06 30 1�a: NW -1/4: SE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4683 Schneider Dr. Oregon, WI 53575 <br /> ❑Sanitary permits <br /> CSM LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Mudroom,Addition to Kitchen, New Three Season Porch ❑ Zoning District <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> '4 This 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 /> 20.0 1.0 Cl 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: � 0 ❑ ErosionControl ntrol permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (Slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR. 3RD FLOOR: q <br /> 25 $ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available O tions. <br /> (Please round to nearest dollar) -+ ♦ ♦ ♦ ♦ '4 $ 75,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ❑✓No ❑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? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes INNo <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 EINo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓❑flo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(wos) <br /> (Continue on Back) ■ —► <br />