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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> • <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jim Cisler <br /> 1.a 1,7 g etas; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 442 S Burr Oak, Oregon,WI 53572 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)835-7705 jim.cisler @frontier.com Site drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Rob Montgomery ❑Site PI ' luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w tic <br /> 119S Main St <br /> (City,State,Zip) (City,State,Zip) 14. I48 <br /> Cottage Grove, WI 53527 . <br /> PHONE PHONE ❑Site •I-- approval from <br /> • (608) 839-4422 a .:ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rob @ma-rs.org i IN Floor plans to scale N <br /> PROPERTY/LOCATION INFORMATION (hftp://aceessdane.co.dane.wLus/) Elevation o property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: \ <br /> ❑PARCEL 0610-051-4474-6 R-2 0.36 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Dunn . 5 1/n: NE +/4+/: • SW ❑Drive ay mits <br /> ADDRESS: (state nty,town, /-11_ <br /> 3051 Shaw CT <br /> ❑S .ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT Ib41 ivate) <br /> Waucheeta <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Bum Sa r-{-c,4-. focrL,. 2ing District <br /> . ❑This project is a new building or structure. P miffed Use? <br /> 151This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Rural Address <br /> 174EWER rEPTIC (ne __' ___ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' ' vt <br /> 18.0 1.0 Li Wetlanog•odpla'.i <br /> C-Shore1 (attac- ent) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> A ErosionCOntr• •ermit <br /> BASEMENT: 1ST FLOOR: <br /> Q • �, J I t'l,I .ftt 4, TOTAL SQUARE FOOTAGE: ,, (S •• , .ISturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> - filli • - - <br /> 1 al-Keview Location Su <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -r ♦ «���>t�tu� and available options. 1, <br /> (Please round to nearest dollar) R• . <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 o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ekes O <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ✓ao <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 Ilo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes I No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) ■ ■ -+ <br />