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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER PROVIDE <br /> OWNER NAME <br /> Wayne Jones ❑ Zoning ,. us;CUP; <br /> OWNER ADDRESS(Number,Street.Cllr,state,ZIP) Deed Re.triction;CSM <br /> 1-762 Hwy 78 Pit. Horeb 1I 53572 aria .. (# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> 4 — 21 ' to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tom Reece , SAC :fireless S'e Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> 8426 Elderberry Rd <br /> (ON.stole,ZIP) (City.State,Zp) Setbacks <br /> N dison, WI 53717 <br /> PHONE PHONE ❑ Site Plan a al from <br /> 698-8968 applica ip. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> -reeve^ 0 loor anstoscale <br /> PROPERTY/LOCATION INFORMATION (http:/accessdane.co.dano.wi.us!) <br /> PARENT PARCEL NUMBER: CURRENT ZONING. - ACREAGE: Elevation of property <br /> to PARC6 EL II 10/ (t — _ Q 76.3 total frontage dr o scale. <br /> NuM <br /> 0606/ ❑ Driv a <br /> TOWNSHIP' ON: <br /> Blue Mounds .' 3 yy-os of -7 NE 14: S'W %IA: y permits <br /> ( te,county,t• n) <br /> ADDRESS: <br /> 1762 Hwy 78 0 S:nits :rmits <br /> CSM (�O tJ LOT / 1 BDIViS10N BLOCK/LOT , .- ,private) <br /> �� <br /> �(( i 1 <br /> PROPOSED PROJECT INFORMATION <br /> lIiRF.'Re1/lIEIAt <br /> PROJECT DESCWPTION: <br /> Proposed 165' cell tower and 50 sq ft compound .4.. ningDistrtct <br /> . II This project is a new building or structure. ii, 5 X-2 <br /> This project is an addition/alteration to an existing building or structure. 3 ( <br /> Q .Pew . <br /> SANITARY SERVICE: PERMIT NUMBER 0 Rural '1. <br /> n a 0 SEWER U SEPTIC (new ' sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not Including basement) <br /> g 10' 1 ❑ Wetland/Fl. :in/ <br /> bid <br /> AREA TO NEAREST SQUARE FOOT: Sh0 : ->• (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) © Eros)• • irtTaR <br /> BASEMENT 1ST FLOOR: <br /> 3I O + TOTAL SQUARE FOOTAGE: 4, ($10!.;-, . s .'m s, <br /> fi :Iaccess) . <br /> 2ND FLOOR: 3RD FLOOR: 3 j D <br /> - -� a ew t catio l Survey, <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► ♦ ar�diitaible options. <br /> (Please round to nearest dollar) $ 18,000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IN No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes C�.3No J 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? D Yes IRINo <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) attached ❑Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes =' No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) •a► -► -► <br /> 545.112(4A9) <br />