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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Joseph Hansen <br /> ['Zoning Status;CUP; <br /> 1 g1 estrelLane,ttlue'bounds, WI 53517 Deed Restriction;CSM <br /> Variance(# ) <br /> HOM PH NE CH-441,02374 E-MAIL ADDRESS <br /> 14702374 hansenj77 @gmail.com ['Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> 411E dyer cgtergetremrEWorld LLC <br /> ❑Site Plan including location <br /> T b regnd Dr CC1g6cIrcellandR r of well/septic <br /> �C�'ty,state, 'p) ( state,Z' ) ❑Setbacks <br /> Wauna' ee, WI 53597aunakCee, WI 53597 <br /> PHONE 6084443749 PHONE 6084443749 El Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDFjESS E-MAIL ADDRESS <br /> timdyer1@gmail.com timdyer1@gmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> El Elevation of property <br /> PaZat -�62-8540-5 CURRENT ZONING: <br /> 0 PARCEL ACME: <br /> frontage drawn to scale. <br /> NUMBER [[ y <br /> TOWNSHIP: SECTION: <br /> Town of Perry ,A. ,/,/a. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1705 Kestrel Ln,Town of Perry (for Home of 1651 Kestrel) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> DEWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: 9 FT NUMBER OF STORIES: (Not including basement) <br /> ❑ 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: ❑ <br /> ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 750 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available O tions. <br /> (Please round to nearest dollar) _11,. -+ ♦ '� -0. -1. S 35,000 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des DJo lon't know <br /> 2. Is there a wetland or floodplain on or near the property? Des ,/No Djon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes —No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Ilo <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 ,/Vo EDon't know <br /> 7. Is this to correct a violation? ❑Yes ✓,lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -* <br />