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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 /> Christopher Rayne <br /> El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 9200 County Road G, Mount Horeb,WI 53572 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)832-6246 (608)577-2813 rayneillustrationanddesign @gmail.com <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Owner Owner <br /> Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City.State,Zip) (City,State,Zip) 51 Setbacks <br /> PHONE PHONE SI Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 51 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0 Elevation of property <br /> PARENT PARCEL NUMBER 2.q •-, `{JJ CURRENT ZONING: ACREAGE: <br /> 0 PARCEL 48/0507-3048000-3 o A-1 (EX) 74.00 frontage drawn to scale. <br /> NUMBER ( ) <br /> TOWNSHIP: SECTION. <br /> Primrose < ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 9200 County Road G, Mount Horeb, WI 53572 <br /> CSM LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 26'x 36'pole shed 0 Zoning District <br /> . NI This project is a new building or structure. 0 Pitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> °- <br /> SANITARY SERVICE: PERMIT NUMBER. 0 Rural Address <br /> EWER 1EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 18.0 1.0 Q Weiland/Fladdelaini <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r-1 r ionCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 936.0 j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR. 3RD FLOOR <br /> flling/access) <br /> 936.0 0 Review L•8-:t• . urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ p and ava „`s;e $i.bo bons. <br /> (Please round to nearest dollar) S 3,000.00 L„ <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 ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Mho <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) Ekes SINo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes rANo <br /> APPLICATION MUST BE SIGNED <br /> 545-112 ta;os> (Continue on Back) -, -► -► <br />