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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 /> The Third Door LLC <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 0 Zoning Status;CUP; <br /> I eed Restriction;CSM <br /> 1523 State Highway 78 �_:_ ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> . 11111fri Site Plan drawn to scale ' <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Andy Mlsna same as agent �- <br /> � Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS - e.tic <br /> 1523 State Highway 78 /DO t f 2//OD <br /> (City,State,Zip) (City,State,Zip) ,M Setbacks / <br /> Mount Horeb,WI 53572 <br /> PHONE PHONE Site Plan approval from <br /> (608) 212-0750 applicable township. /V <br /> ADDRESS E-MAIL ADDRESS <br /> info @misnahomes.com 'Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> yisr, <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ,jlevation of property <br /> 0 PARCEL 0606-221-8085-0 C-2 3.19 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Blue Mounds 22 l/; NE %I/: NE 6Driveway permit <br /> ADDRESS: (state,county,lL ']�'It) <br /> 10043 Blessingway Rd, Mt. Horeb, WI 53572 <br /> jSanita yiii�+ • <br /> CSM: 1 0,980 LOT 3 SUBDIVISION BLOCK/LOT (pub' ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �-- ( v t /d mini storage > �( / b X / Zoning District (-- <br /> . This project is a new building or structure. '^ ' <br /> Permitted Us <br /> This project is an addition/alteration to an existing building or structure. �" ' ''`� 1 <br /> SANITARY SERVICE: PERMIT NUMBER: i Rural <br /> EWER EPTIC ti <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10.0 1.0 r ' Wetland/Fioodplain/ 4 0 <br /> :land (attachment) <br /> AREA TO NEAREST SQUARE FOOT: -- 3// <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) / /� <br /> BASEMENT 1ST FLOOR: <br /> ,P..', ErDS1onControl 0 3r'. <br /> 6,000.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, -/ L4J L <br /> • - aFC. f _ <br /> 2ND FLOOR: 3RD FLOOR: 6,000.0 � <br /> ESTIMATED CONSTRUCTION COST: Q� �r-,{Review Location Survey A <br /> (Please round to nearest dollar) ♦ -► -, -, ♦ -♦ $ 75,000.00 and available options. ��' <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? IYes E4o ['Don't know <br /> Q✓ <br /> 3. Have you talked with the township about your project and are they in agreement? Yes Io <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes L o <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 ✓aJO QDon't know <br /> 7. Is this to correct a violation? [Yes ato <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ -► -► <br />