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f lo&-o 4 or( r <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Bob & Helen Johnson <br /> III Zoning Stat s; CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zip) Dee Res iction; CSM <br /> 541 Union Road,Brooklyn,WI 53521 Varia c # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)455-4701 albanyair @frontier.com ❑Site Plan drawn scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include Ttensions <br /> AGENT NAME CONTRACTOR NAME <br /> Meigs Inc.-Dave Budden Meigs Inc.-Dave Budden ❑Site Plan in ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se is <br /> P.O.Box 412 P.O.Box 412 <br /> (City,State,Zip) (City,State,Zip) ❑Setb <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> Ili <br /> PHONE PHONE ❑Site Pla ':•• + from <br /> (608) 767-2729 (608) 767-2729 applica"/et• shi•. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.com ❑Floor plans cale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of ro rty <br /> ❑PARCEL 042/0509-261-8395-0 A-2 22.08 frontage dra to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Oregon 26 %: NE 1 + NE ❑Drive y ml <br /> g �4. �4�4. <br /> ADDRESS: (state ,t U f�J <br /> 541 Union Road <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanita p'rr�tltS(� _ ,�, <br /> 13,120 1 (publi•�•ri )-1`�( ���/ <br /> PROPOSED PROJECT INFORMATION STAFF VIEW <br /> PROJECT DESCRIPTION: <br /> 14'x 47'addition onto existing out building ❑ Zonin trict <br /> . ❑This project is a new building or structure. ❑ Permitted fie? <br /> This project is an addition/alteration to an existing building or structure. vv <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Addr <br /> EWER [EPTIC (new/exit <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 12.8 1.0 ❑ Wetland/ : •• ,, . <br /> Shorela , =ch ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> ❑ Erosion • •. •ermit <br /> 658.0 + TOTAL SQUARE FOOTAGE: j (slopes • - , • , -, <br /> 2ND FLOOR: 3RD FLOOR: filling/- Ce + <br /> 658.0 ❑ Review'FAQ,c&ti•A. • - <br /> ESTIMATED CONSTRUCTION COST: and av °.,,& ' t •ns. <br /> (Please round to nearest dollar) ♦ ♦ $ 18,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑✓No <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) Dyes Jlo ['Don't know <br /> 7. Is this to correct a violation? Elves ❑✓No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► -. <br />