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t ' ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU- OMER TO PROVIDE <br /> OWNER NAME <br /> Erik & Amy Berning �� Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> 1702 Sand Hill Road, Oregon,WI 53575 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)712-7067 berning.amy @gmail.com ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Self contracting I <br /> g Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS iof well/septic <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> PHONE PHONE ❑Site Plan ap val from <br /> pplicabl ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> II, Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn !, Elevation of property <br /> ❑PARCEL PARCEL <br /> O�03d3 t(.046) CURREjJT ING ACREAG : <br /> d '/ ����((\\ I frontage drawn scale. <br /> NUMBER _ <br /> TOWNSHIP: SECTION: ��, 11 <br /> • Dunn .3a '/a: WA: 1)'V❑Drivew ermits <br /> /�,,, (stat county n) <br /> ADDRESS: 5041. HM (-{ Oa�P-3 O,� ' '�, <br /> CSM LOT J SUBDIVISION BLOCK/LOT ❑$anita eate) <br /> (publ. ,private) <br /> PROPOSED PROJECT INFORMATION STAFF'REVIEW <br /> PRO ECT DESC IPTION: <br /> pa c,i, 3 65e 1K J r , /--fcc.r, e 1t- 5 i 611 k1 Zoning District <br /> ❑This project is a new build' g or structure. °w ShQ4 ce--e,'.1 VIA 14 Id I <br /> 0. Permitt- -e? <br /> his project is an addition/alteration to an existing building or structure.�M1 a <br /> ANITARYSERVICE: PERMIT NUMBER: ❑ Rura • •'re8s . <br /> EWER 'EPTIC (newI <br /> HEIGHT IN FEET: 11 I NUMBER OF STORIES: (Not including basement) <br /> .1- ❑ 1Netlan• . •••plain! <br /> Shore', • (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfini he are ttached arages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ �rOSIOrICOtltrol It <br /> Za ��tt/ j TOTAL SQUARE FOOTAGE: ,, (slopes,dis( •=nce, <br /> 9 filling/:.«-.. ,) ,� <br /> 2ND FLOOR: I R (0 it r ` <br /> 1M ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ r ' and available options. <br /> (Please round to nearest dollar) S so° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? il' -s ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I/ es o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 1Vo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank i none) <br /> 6. Is a location survey required? (see reverse) Yes o ❑Don't know <br /> 7. Is this to correct a violation? [Yes 'pc) <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -i -► <br /> 545-112(4/08) <br />