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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 /> Dale E. Lund E4oning Status;CUP; e��+t`— <br /> ` <br /> OWNER ADDRESS(Number,Street,City,Stare,Zip) Deed Restriction;CSM ~ <br /> Ss/ 1281 Bills Road,Cambridge,WI 53523 Variance(# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> (608)334-4857 i (608)334-4857 DaleE1749©gmail.com Site Plan drawn to scale r <br /> AGENT INFORMATION 'CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME V-GA--r/f <br /> Hausz Contractors INC 0 Site Plan including location , ^'^ <br /> AGENT ADDRESS 111 CONTRACTOR ADDRESS of well/septic 1144110 <br /> �\ 89 Hoopen RD <br /> (City,State,Zip) \ (City,State,Lp) dSetbacks <br /> Cambridge WI 53523 <br /> PHONE PHONE [Site Plan approval from <br /> (608)206-5623 applicable township. P`s p <br /> E-MAIL ADDRESS E-MAIL ADDRESS ,,��(( <br /> hauszcontractors@gmail.com LJ Floor plans to scale <br /> PROPERTY:LOCATION INFORMATION (http:iaccessdane.co.dane.wi.us)) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> DPARCEL 0612-322-8710-0 g/_ / '7�-)0 zoo frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: I <br /> Christiana 1/4: NW t1�4. NW Driveway permits N s <br /> ADDRESS. (state,county,town) <br /> 1281 Bills Road, Cambridge,WI 53523 <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits N,1Q <br /> Lot 1 (public,private) 1 <br /> PROPOSED PROJECT INFORMATION STAPP <br /> PROJECT DESCRIPTION: r- <br /> F e.S ACC_ ♦ di Zoning District <br /> . o This project is a new building or structure. ) SrPermitted Use? <br /> This project is an addition/alteration to an existing building or structure. �e�/ <br /> SANITARY SERVICE: PERMIT NUMBER: Yl "' R�Ad�.r�dr�yd.ss� V 416 <br /> FEWER JEPTIC // 1 ( ) <br /> HEIGHT IN FEET: 1 S NUMBER OF STORIES: (Not including basement) eG bedol�n+ <br /> 1.0 Shoreland^(ryr dwnsnt° ) 11•1lA <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rf E.r�©, eCo &p <br /> BASEMENT: / 3R FLOOR O/ +TOTAL SQUARE FOOTAGE: + t� (slopes,disturbance, <br /> ~I� <br /> / s� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 2,016.0 <br /> Review Location Survey IA <br /> ESTIMATED CONSTRUCTION COST: $ �j and available options. VI <br /> (Please round to nearest dollar) $ 5(� <br /> 1.The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes '10 QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1/ o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? EYes Dgo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'lo <br /> 5. Is this project associated with a rezone/CUPNariance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Yes Epo EiDon't know <br /> 7. Is this to correct a violation? QYes }io <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - -► -I, <br /> 545-112(4/08) <br /> N a .avS114tS.5 <br /> - N 0?..v,r...,12,,>~` <br />