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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> James A Gryzynger oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 2862 Door Creek Road Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> b;-; .:' / /:- 4- _:�[ = [ >t l 4. ° ■A,.r s. I. eL q"itellan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Pinno Buildings-Brad Cheske l a-Man including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5540 State Road 50 Suite 102 <br /> (City,State,Zip) (City,State,Zip) • etbacks <br /> Delavan,WI. 53115 <br /> PHONE PHONE Ite P :I .•proval from <br /> (608) 295-5141 applica• e •wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bradc @rapinno.com loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> ❑PARCEL 046/0611-071-8200-2 RH-1 -'`)`f/ 5.01 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT ON: <br /> Town of Pleasant Springs 1A: N £ ,,,,,A:tit- ❑D ' permits <br /> ADDRESS: (stat ,co ty,town) <br /> 2862 Door Creek Road <br /> CSM: LOT SUBDIVISION BLOCK/LOT an f.* •-rmitS--- <br /> 15 I (public, • 'vats) U <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New 30'wide x 40'long with 10' porch Post Frame Storage Building onin District <br /> . t7 This project is a new building or structure. ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. p,,� <br /> SANITARY SERVICE: PERMIT NUMBER: '--[y'°'al Address <br /> E)EWER '�/pEPTIC (new/Epp <br /> HEIGHT IN FEET: y� NUMBER OF STORIES: (Not including basement) <br /> 18.0 1.0 ❑ Wetland/Fl.•. 'lain/ <br /> Sho - attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErOSI•nC• rot permit <br /> I + TOTAL SQUARE FOOTAGE: ,` (slope .-' turbance, <br /> 2ND FLOOR: 3RD FLOOR: � a flilin((ace-:.) <br /> 1 ,200.0 V1 ❑ Review Lo ion Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► -► ♦ � f� \\�� and avai options <br /> round to nearest dollar) / �� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ✓J' o ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? f Yes Do 0 Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? f Yes EINo <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) ❑Yes 'lo DDon't know <br /> 7. Is this to correct a violation? QYes Ilo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />