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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Anton & Bernadette Beutler ❑ Zoning Status;CUP; <br /> OWNER ADDRESS( ,Street.City.State.Z)p) Deed Restriction;CSM <br /> 28 St Hw• 6• N- G . 4 Variance(# ) <br /> HOME PHONE ■CELL PHONE E-MAIL ADDRESS <br /> 424-99. 9 ' bernieanatony @tas.ne-c ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tom Reece, 6AU wireless ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 8426 Elaerberry Rd <br /> (city.sale.zip) (City.stets,Zip) ❑ Setbacks <br /> Madison, oa 55717 <br /> PHONE PHONE ❑ Site Plan approval from <br /> 698-8968 applicable township. <br /> E-MAILADORESS E-MAIL ADDRESS <br /> treece@sacw.com ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/,accessdane.co.dane.wi.usi) Elevation of PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property <br /> D PARCR 040/0508-312-91711-0 1 .73 frontage drawn to scale. <br /> TOWNSHIP: SECTION: L.1 DriVBWa <br /> Montrose 8V/ 1/4: N��J 1/4%: y permits <br /> (state,county,town) <br /> corner of Old 69 & Hwy 92 <br /> CSM: LOT `SUBDIVISION BLOCK/LOT ❑ Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 170' comm tower with 80 sq ft compound ❑ ZonitlgDiatrlct <br /> . 3 This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER U Rural Address <br /> no ❑SEWER 0 SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement)bldg 10' 1 ❑1NeUand /FIOOdptain/ <br /> ,Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erosioncont p irmit <br /> BASEMENT: 1ST FLOOR: 0 i TOTAL SQUARE FOOTAGE: i (slopes,disturbance i <br /> .3/ filling/access) <br /> 2ND FLOOR: 3RD FLOOR <br /> ' - Z Q Review Location"Survey; <br /> ESTIMATED CONSTRUCTION COST -4. ♦ -. Q and available"options. <br /> (Please round to nearest dollar) $ 18 1 000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 3 No U Don't know <br /> 2. Is there a wetland or fioodplain on or near the property? ❑Yes IN No !"i Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? iiii Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No <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) p.:.t.asCJii i. ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes .'No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) •► -► -4P• <br /> 545-112(4108) <br />