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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 /> Wayne and Sue Wulff <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1429 Raven Oaks Trail Oregon,WI 53575 Variance(# ) <br /> HOME PHO CELL PHONE _ E-MAIL ADDRESS <br /> J /c !ems-51 -Vigi w5wutff@aim.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Brian D Buss,president Buss Construction,Inc. Buss Construction, Inc. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5780 Enchanted Valley Rd. 5780 Enchanted Valley Rd. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Cross Plains,WI 53528 Cross Plains.WI 53528 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 798-1000 (608) 798-1000 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> brian @bussconstruction.com brian @bussconstruction.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT P QR � MBE CURREN NI : ACREAGE: <br /> ❑PARCEL Q ® 'j�,0 frontage drawn to scale. <br /> NUMBER r lit, <br /> TOWNSHIP: SECN: <br /> OR4'6j-Al .1/4: %oh: ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> 1429 Raven Oaks Trail Oregon, WI 53575 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> I =A � 4.1 (public,private) <br /> PROPOSED PROJECT INFORMATION Xd771 STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 446eeeb404 ,4'P/7b4/ ❑ Zoning District <br /> . ['This project is a new building or structure. ❑ Permitted Use? • <br /> 12 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER I( EPTIC (new/existing) <br /> HEIGHT IN FEET ^ 7 /�_1�+ NUMBER STORIES: (Not including basement) <br /> �/ ❑ Wetland/Floodplain! <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached gars above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: O 1ST FLOOR: 1 TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 3 `�•�' b illing/ac cess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ~ c Sk ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: - ♦ ♦ ♦ ♦ //� ,cam and available options. <br /> (Please round to nearest dollar) $ f ` v / L/�� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes l o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 410 <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 "lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Jio <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ -+ <br /> 545-112(4/08) <br />