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62 , � � <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Benjamin F. Becker ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zp) Deed Restriction;CSM <br /> 4799 Missouri Rd., Marshall,WI 53559 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> —> (608)547-2574 bfbecker2024 @yahoo.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeff Krueger ) 32Ø'o( 0 {Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Gv/067. ge.e&/-i i <br /> (City,State,Zip) (CI,State,Zip) ^ ❑Setbacks <br /> sw/ ,. et/1 ,5...g577 <br /> PHONE PHONE ❑Site Plan approval from <br /> (920) 988-2598 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> jeffkruegerconstruction @gmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) at <br /> l io <br /> ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: E eva io drawn property <br /> scale. <br /> El PARCEL 036/0812-344-9095-0 RH-2 4.32 <br /> NUMBER <br /> TOWNSHIP: SECTION ❑Driveway permits <br /> 3 '/•: '/•�"a: (state,county,town) <br /> ADDRESS: <br /> 4799 Missouri Road {Sanitary permits <br /> CSM: LOT 4 SUBDIVISION BLOCK/LOT (public,private) <br /> io�39 �F � .� <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: i n IV; « w <br /> `" <br /> ❑ his project is a new building or structure. . ! . <br /> ►.1 This project is an addition/alteration to an existing building or structure. _# "Y T.ra <br /> SANI "Y SERVICE: PERMIT NUMBER i t ; -' <br /> EWER r)EPTIC <br /> HEIGHT IN FEET: .-.7 NUMBER OF STORIE,$; (Not including basement) <br /> Z G sF # it! . <br /> 3 q:474::Pvil, „7,-.4Q-ri <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) tY t ,tt t tt. <br /> BASEMENT: 1ST FLOOR: C�U ) + TOTAL SQUARE FOOTAGE: + °. t i F ° 2 ik <br /> 2ND FLOOR 3RD FLOOR: 1 7 / (J - ' <br /> i rt ri <br /> ESTIMATED CONSTRUCTION COST: •'' 't , <br /> (Please round to nearest dollar) S/ 000 s. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes Olio ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I! es No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? 10t es _No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? {Yes o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave b ank if none) <br /> 6. Is a location survey required? (see reverse) {Yes 0, o ❑Don't know <br /> 7. Is this to correct a violation? {Yes �� o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ■ —► <br /> 548-112(4/08) <br />