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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 /> Jim Cisler <br /> ❑-zQ n Itus;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 /> 1 S <br /> (City.State.Zip) (City,State.Zip) I ri P6. <br /> Cottage Grove, WI 53527 "�tV"'rrrr <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 51 Floor plans to scale . <br /> PROPERTY/LOCATION INFORMATION (http:laccessdane.co.dane.wi.us/) Elevation property PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE o p P Y <br /> ❑PARCEL 0610-051-4474-6 R-2 0.36 '.--......frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP SECTION <br /> Town of Dunn 5 1/4: NE %IA: SW ❑Drive to ay nt mits <br /> ADDRESS_ 3051 Shaw CT ( y,town /■3 iia <br /> ❑S A•' r .ermits <br /> CSM LOT SUBDIVISION BLOCK'LOT •publ VA ivate) <br /> Waucheeta <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Building Additiontc`-- 'f` Wing District <br /> . OThis project is a new building or structure. P miffed Use? <br /> '4 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 174EWER rEPTIC (ne ____ �' 'I* <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ( 1 � <br /> 18.0 1.0 ❑ Wetlan•'odpla';� i� <br /> Cs AREA TO NEAREST SQUARE FOOT: <br /> hore (a ac ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> II ErosionContr• •ermit <br /> BASEMENT 1ST FLOOR <br /> 1.3...1...S + TOTAL SQUARE FOOTAGE: j (S••- , •isturbance, <br /> 2ND FLOOR: 3RD FLOOR <br /> fills re-PC- <br /> 13SS a eview Location Su <br /> ESTIMATED CONSTRUCTION COST: and available o dons. <br /> (Please round to nearest dollar) '♦ "+ ♦ -♦ .- ♦ $ 1 50,000.00 P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ❑No DDon't kn•w <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? QYeslo <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) ❑Yes 'Jo DDon't know <br /> 7. Is this to correct a violation? ❑Yes ow <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) <br /> (Continue on Back) -4. -i -► <br />