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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME DEERFIELD ROD & GUN CLUB INC <br /> gE-1 - q <br /> OWNER ADDRESS (Number,Street,City,State,Zip) I0 Zoning Status; CUP; ' �p <br /> Deed Restriction;CSM Po <br /> PO BOX 47 DEERFIELD WI 53531 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)764-5811 Site Plan drawn to scale PO <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions)/ <br /> AGENT NAME CONTRACTOR NAME <br /> STEVE GRAMS- BOARD MEMBER GROB CONSTRUCTION#954918 j"� <br /> Site Plan including locat� <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic 46- -1 <br /> 195 COUNTY RD BB 3761 SKY HIGH RD <br /> (City,State,Zip) (City,State,Zip) Setbacks 63b°71/6/2 <br /> MARSHALL WI 53559 COTTAGE GROVE WI 53527 C <br /> PHONE PHONE Site Plan approval from <br /> (608) 347-5664 (580) 660-8770 applicable township. ,"/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> EVETS1952 @GMAIL.COM GROBCONST @GMAIL.COM ►i Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> E PARCEL 0712-102-9001-0 RE-1 40.53 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> DEERFIELD 10 1/4: NW ": sw ZDriveway permi <br /> ADDRESS: • it town) 1 <br /> 4372 DEERFIELD ROD AND GUN CLUB >r <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT '/' <br /> (public, riv hi c4kr,c' <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: RE <br /> ADDITION OF HANDICAP ACCESSIBLE BATHROOOMS /Zoning District <br /> ❑This project is a new building or structure. 6 ��� <br /> Permitted Use? <br /> 12 This project is an addition/alteration to an existing building or structure. Ata(g,4 0a- <br /> SANITARY SERVICE: PERMIT AeW —17 6 3.3 (new _. , _ <br /> YEWER �/ EPTIC (new/;)=Ti <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 16.0 1.0 %.)0 5W- -:�Floodplain/ �/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> •, (attachment) 1�47i¢-- <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionControl permit <br /> 756.0 756,0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, 76 <br /> filling/access) Ape <br /> t <br /> 2ND FLOOR: 3RD FLOOR: v <br /> 1,512.0 ��rr�� <br /> ESTIMATED CONSTRUCTION COST: A Review Location Survey .1/ <br /> (Please dollar) -• -• -' -► .- -• $ 130,000.00 and available options. /'"v 4 <br /> Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes DNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes llo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? E✓Yes Ilo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/a speal# ) (leave blank if none) <br /> 6. Is a location survey required? (see rever - ❑Yes ✓�Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ao <br /> . ."..' /6' l" t VO APPLICATION MUST BE SIGNED <br /> 545-112(4i0e) (Continue on Back) -► --t• <br />