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ZONING PERMIT APPLICATION www.countyofdane.com r�''JJ"R"ia'"c.i'rq,12" ':' <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Nathan and Caitlin Weitzel <br /> Boning Status; CUP; <br /> 645 1r8ErsOVe u gtreetet. eeasburg, WI 53959 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-393-3528 608-393-1564 cbrittg @yahoo.com E{Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME RiNg a-Weifzel <br /> 12/Site Plan including location <br /> AGENT ADDRESS C NT CTO ADDRES of well/septic <br /> 6�45�1. rove Street <br /> (City,State,Zip) WeecTS Virg, WI 53959 �etbacks <br /> PHONE PHONE Site Plan approval from <br /> 608-393-1564 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRE S <br /> cbrittg@yahoo.com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ❑PACET L P4 d 43-4222-0 CURRENT O INA: Ac i17: El/Elevation of property <br /> frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT I N: SW �rlvewa <br /> Town of Springfield ,�4: NE WA: y permits <br /> ADDRESS: Lot 12 Amethyst Drive, Waunakee, WI 53597 ( tate, county,town) <br /> Sanitary perm kir / <br /> CSM: LOT 12 ping eld Ridge BLOCK/LOT (public, private) l <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> P QJE T D SCRI TION: <br /> IngSe I€amity residential- ��r" -X� g Zoning District �=j <br /> - 5This project is a new building or structur'- ' '•� vm we <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. . <br /> ❑ Rural Address - _- : ri-ry <br /> SANITARY SERVICE: PERMIT NUMBER: 13-2016-00065 _7 <br /> [)EWER IEPTIC (neW/eXISting) /D` <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 1 1 ❑ Wetl oodplaln/ <br /> Sh an (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) EroSl rolpermit /� <br /> BASEMENT: 1ST FLOOR: ` ) l� 97 <br /> L/� 61' /d' TOTAL SQUARE FOOTAGE: l (SI ,di rbance, <br /> 2ND FLOOR: 3RD FLOOR: ,�/ /� filling/acces ) <br /> �"'' /; eview Location-Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available opfiiAl; <br /> (Please round to nearest dollar) 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Ekes EiNlo EJon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,./No DJon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ekes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes Dlo <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) Ekes lo DDon't know <br /> 7. Is this to correct a violation? ❑Yes o <br /> CAUSE ED <br /> (Continue APPLI on TION BacMk)T B♦SIGN—► —► <br /> SdS-11,td/11P1 <br />