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se---/ ((, ,cio <br /> ...... <br /> \ye" ,),(4,,GCS)P-) q 44 —A-1 (9--- <br /> SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Tim Andrews <br /> OWNER ADDRESS (Number,Street.City,State.Zip) ID Deed Status;CUP; <br /> 9751 Wilkinson Rd.Mazomanie WI 53515 Deed Restriction;2.327 ; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)795-9948 (608)445-9636 tahort @gmail.com 12 Site Plan dra n scat <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes . ensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ken Meigs Meigs Inc. fl Site Plan i clu location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/sept <br /> 1527 State St. 1527 State St. <br /> (City,State.Zip) (City.State,Zip) IS Setbk7kv <br /> Black Earth WI 53515 Black Earth WI 53515 <br /> PHONE PHONE I© Site Plan appr al from <br /> E-MAIL ADDRESS (608) 767-2729 (608) 767-2729 applicabl t nship. <br /> E-MAIL ADDRESS <br /> Ken @meigsbuilds.com Ken @meigsbuilds.com ! Floor plans to scale K' Cce.Jte, <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLusl) 0 Elevation of property rJ <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: I <br /> i�PARCEL 034/0806-012-9180-0 Al-EX frontage drawn to scale. e <br /> NUMBER <br /> TOWNSHIP SECTION: <br /> Mazomanie 1 1/,; SW +/4/4. NW NI Driveway permit <br /> ADDRESS (state,co ty, wn) <br /> 9751 Wilkinson Rd, Mazomanie WI 53515 <br /> El CSM: LOT SUBDIVISION BLOCK/LOT Sa it- ItS <br /> (pub.. . - ,) <br /> PROPOSED PROJECT INFORMATION ST• FF REVIEW <br /> PROJECT DESCRIPTION <br /> New Storage-Office-Shop Builiding ❑ Zoning District <br /> . Fd This project is a new building or structure. ❑ Permitted Use? 19-65 <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ ' Address <br /> EWER PEPTIC I S 201 Iaa l` -xisting) 0 n <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) /Vpvt"t/'� <br /> 23.9 1.0 ❑ 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) p d c4,050.0 ��� <br /> BASEMENT: 1ST FLOOR: ❑ Erost nCon. I erm <br /> ,, TOTAL SQUARE FOOTAGE: ,, (slope urbance, <br /> filling/a ss) �7.,,t /_02.414, <br /> 2ND FLOOR: 3RD FLOOR: LQl tG <br /> 4,050.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -� -6* -r - -� $ 258,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? E Yes ONo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Oyes Fro 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? ['Yes EliNlo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#2,327 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [ fres No DDon't know <br /> 7. Is this to correct a violation? QYes ✓Jlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► -► <br /> 545-112(4/08) <br />