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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 /> Paula and Dale Luhman ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number.Street,City.State,Zip) Deed Restriction; CSM <br /> 3689 Old Military Rd,Cross Plains,WI 53528 Variance(# <br /> HOME PHONE ;CELL PHONE E-MAIL ADDRESS <br /> (608)712-7715 (608)712-7715 dluhman.mrsparks@gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRAL.fOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dale Luhman 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3689 Old Military Rd <br /> (City,State,Zip) (City.State.Zip) ❑Setbacks <br /> Cross Plains,WI 53528 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 712-7715 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dluhman.mrsparks @gmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0707-261-8350-8 RH-1 DCPREZ-0000-03957 2.06 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION <br /> Cross Plains 26 1/4; NE /1/. NE ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> 3689 Old Military Rd <br /> CSM 4,175 LOT 1 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> LOT I CSM 4175 CS17/2738274 R4868a4585813o183 DESCR AS SEC 26-7-7 PRT NWII4NE1/4(2.06 ACRES INCL RD RIW)SUBJ TO ESMT TO MADISON GAS&ELEC CO IN 69687/13 ❑ Zoning District <br /> . IN This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: IN/AI PERMIT NUMBER: ❑ Rural Address <br /> fEWE EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 20.0 / ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR ❑ ErosionControl permit <br /> 1,584.0 j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR- 3RD FLOOR: filling/access) <br /> 1,584.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> $ <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 3,860.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes J[ to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes no ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yeso <br /> 4. Has there been a zoning permit issued for this property i ast 5 years? ❑Yes Imo <br /> 5. Is this project associated with a rezone/CUP/varian (petition ppeal# 3057-) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes Imo DDon't know <br /> 7. Is this to correct a violation? Des ✓alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -► <br /> 545.412(4I08) <br /> (11(1.; <br />