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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 /> Chase an. /J anielle If ang) Ziegler oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City, . - .• Deed Restriction;CSM <br /> 5263 W. Netherwood Rd., Oregon,WI 53575 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)291-2098 crziegler @gmail.com E Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> N/A N/A E Sjt4Plan including location <br /> AGENT ADDR SS CONTRAC •' •DDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) tbacl(S <br /> PHONE PHONE Sit Plan approval from <br /> a plicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: evation of property <br /> ❑PARCEL 050902322125 R-1 DCPREZ-0000-10095 0.47 ronta e drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> J (staTO5NRO9E 2 /4. NW 1/41/4: of SW iveway permits <br /> ADDRESS: <br /> te county,town) <br /> 5263 W. Netherwood Rd. <br /> CSM: LOT SUBDIVISION BLOCK/LOT anitary permits <br /> PETERSON HEIGHTS 2 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Addition of chicken coop Et3Zing District <br /> . EThis project is a new building or structure. rmitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural A• S <br /> EWER I/ EPTIC YV (new/ <br /> HEIGHT IN FEET: NUMBER OF STORI S: (Not including basement) <br /> 4 I ❑ We -nd/F •-'plain/ <br /> AREA TO NEAREST SQUARE FOOT: Sho -nd (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Era •n trot permit <br /> TOTAL SQUARE FOOTAGE: j (slop: disturbance, <br /> 2ND FLOOR: "3RD FLOOR: full g/ac,ess) <br /> / <br /> ❑ Revie _•.F tion Survey <br /> ESTIMATED CONSTRUCTION COST: p and . .i -ble options. <br /> (Please round to nearest dollar) �7 l r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ©Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ©Yes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes No <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 No ❑Don't know <br /> 7. Is this to correct a violation? Elves No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) — -4 -4 <br /> 545-112(4/08) <br />