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ZONING PERMIT APPUCA110N wlrw cou tyofdane:oom .. , <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Dave and Sue Gehl <br /> ❑Zoning s; CUP; <br /> 1 IAeounty 4477t0 faret WI 53572 D d striction; CSM <br /> HOME PHONE C(g�8g�/1 H E 2-6235 E-MAIL ADDRESS ari ce(# ) <br /> Si Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGE T"NAME tr ATOil`remodeling <br /> �,P�5 0-c---J �c�c..(_S S• Plan including location <br /> AGENT ADDRESS C O$I,CgO$argaE6Sr- well/septic <br /> (City,State,Zip) ( ty, r> WI Setbacks <br /> e e I atvze, 53508 <br /> PHONE PHONE <br /> (608)279-1112 El Sit: 'Ian a royal from <br /> a.plica township. <br /> E-MAIL ADDRESS E-MAI L ADDRES <br /> jree324 @gmail.com F F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of pr <br /> PARENT operty <br /> PAR6F�(IJ,J�A�F,�j„-9010-0 CURRENTZQN�IG: ACgF frontage drawn scale. <br /> TOWNSHIP: SEC,TI,ON: S 1:1 Perry C'S1) ,/a: '/%: Dnvewa ermits <br /> ADDRESS: 1261 County Hwy Z, Mt. Horeb WI 53572 (state ounty,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanita ermltS <br /> 6083 2 (p b• , private) <br /> PROPOSED PROJECT INFORMATION S FF REVIEW <br /> PROAECT DE CRIPTION: <br /> Office addition W D e / II Zo ing District <br /> . ❑This project is a new building or structure. ermitted Use? <br /> ❑✓This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A re <br /> FEWER IDEPTIC (neW/e tin <br /> HEIGHT IN FEET: 13 NUMBER OF STORIES: (Not in in basement) <br /> 1 LI Wetland/FI plain/ • <br /> AREA TO NEAREST SQUARE FOOT: ShOrela (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1 ST FLOOR: ❑ ErosionCon permit <br /> N/A 16 x 16 -0)- ) 1 TOTAL SQUARE FOOTAGE: + (slopes, • turbance, <br /> 2ND FLOOR: 3RD FLOOR: tkcA� Z ,� ♦ --26s filling/ ss) <br /> zi 7a _ ❑ Review Location Survey f r .trN <br /> ESTIMATED CONSTRUCTION COST: 20,000 and available options. U <br /> (Please round to nearest dollar) ♦ ♦ ♦ '♦ ♦ ♦ t-1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓as10 DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes ,/No QJon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres laI. <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank t one) <br /> 6. Is a location survey required? (see reverse) Ekes ;irk o DDon't know <br /> 7. Is this to correct a violation? Des V o <br /> ,cs.'- '0 APPLICATION MUST BE SIGNED <br /> \J (Continue on Back) ■ ■ -+ <br /> 515_119/d/f1A1 <br />