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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 /> Nick Hartwig <br /> d Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 401 Sunrise Blvd Moscow,PA 18444 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)370-2008 (608)588-4105 nhartwig©kraemerbrothers.com <br /> 19 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ig Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 151 Setbacks <br /> PHONE PHONE 4 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> d Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Q Elevation of property <br /> ElPARCEL 0907-184-9760-0 A-2(2) 2.24 frontage drawn to scale. <br /> NUMBER . <br /> TOWNSHIP: SECTION: <br /> Roxbury 18 1/4. SE 1/4+/4. SE 0 Driveway permits <br /> ADDRESS: 9300 CTH Y (420' West of 9280 Hwy Y) (state, county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 10,666 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Residence LI Zoning District <br /> . 0 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: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC 13,201,600,354 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 32.0 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT 2,619.0 1ST FLOOR: 2,735.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 5,354.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available o tions. <br /> (Please round to nearest dollar) 'r '' '' '. '♦ '' $ 350,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes rNo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes rNo QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? res /No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes ONo <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 rNo QDon't know <br /> 7. Is this to correct a violation? QYes rNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />