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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 /> James Seabury <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7097 Hwy P,Dane,WI.53529 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)438-0853 jseabu @gmail.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ben Meyer 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> N1774 State Rd 113 <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Lodi WI.53555 <br /> PHONE PHONE 0 Site Plan approval from <br /> (608) 370-2296 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bmeyercon @gmail.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> is <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: Elevation of property <br /> ElPARCEL 022/0908-221-9960-0 A-2 1.72 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION. <br /> Dane 22 1%: 1h: ❑Driveway permits NIA <br /> ADDRESS: (state,county,town) <br /> 7097 Hwy P Dane WI 53529 <br /> ❑Sanitary permits NIA <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 10,717 <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION ' <br /> PROJECT DESCRIPTION: d '-, � 1 <br /> Accessory Building/Workshop ' <br /> . This project is a new building or structure. V.41,:t.::-!-':;.,,,-::::,"::•:' 'V. <br /> ❑This project is an addition/alteration to an existing building or structure. 1.� � �, A <br /> SANITARY SERVICE: PERMIT NUMBER: " �, s ." <br /> .EWER E.EPTIC N ■ �,� �v� i a <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ti <br /> 21.8 1.0 :' ``-Y <br /> AREA TO NEAREST SQUARE FOOT: A- lr-,°�wN° k . i <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) �; <br /> BASEMENT: 1ST FLOOR: ` �� + ,k <br /> 5,000.0 1 TOTAL SQUARE FOOTAGE: ,4, , r ;Z ' <br /> u �. <br /> 2ND FLOOR: 3RD FLOOR: �' fi <br /> 5000.0 <br /> ESTIMATED CONSTRUCTION COST: a , <br /> (Please round to nearest dollar) -* . -� 115,000.00 � At#. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes riNo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ONo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? :Yes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes NI No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# 11,°57 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes ONo Don't know <br /> 7. Is this to correct a violation? Eves rANo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 ♦ -► <br /> 545-112(4/08) ) <br />