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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 /> • 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 401 Sunrise Blvd Moscow,PA 18444 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)370-2008 (608)588-4105 nhartwig@kraemerbrothers.com <br /> 151 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> PHONE PHONE 4 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P rty <br /> ❑PARCEL 0907-184-9760-0 A-2(2) 2,24 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP. SECTION: <br /> Roxbury 18 '/4: SE 1/4+/4. SE 12 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9300 CTH Y (420' West of 9280 Hwy Y) p Sanitary <br /> CSM: LOT SUBDIVISION BLOCK/LOT permits <br /> 10,666 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Reeidease. laeVe_ sh PC/ ❑ Zoning District <br /> i <br /> . his project is a new building or structure. ❑ Permitted Use? <br /> is project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI 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 /> BASEMENT 1ST FLOOR: ❑ EtOS1011COntrOlpermlt <br /> f 1500 2;743&g: <br /> 4, TOTAL SQUARE FOOTAGE: ,, '(slopes disturbance, <br /> filling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 j5-00 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 350,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? f Yes ONo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 9No QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓QYes No <br /> 4 Has there been a zoning permit issued for this property in the past 5 years? :Yes ONo <br /> r.4 , <br /> 5. s a Is p o ect associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> i e'required? (see reverse) EYes jNo QDon't know <br /> „:; All (e t•1,41;P'- r t&olation? EYes rdNo <br /> }" APPLICATION MUST BE SIGNED <br /> 'T (Continue on Back) -. -► <br /> 545-112 6;,1 ,� <br /> — - <br />