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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Corey Kvalo ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4866 Pine Spring Rd De Forest,Wisconsin 53532 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)977-1745 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Morton Buildings, Inc. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> W1190 American Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Ixonia,WI 53036 <br /> PHONE PHONE ❑Site Plan approval from <br /> (920) 261-9151 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> christopher.trimbom @mortonbuildings.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL 0911-161-9220-1 A-1 Agriculture district 10.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Bristol 16 IA: NE %o : SW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2596 Rail Rd <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 60'x48'Farm-Insulated Shop ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> 0 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 18.0 1.0 ❑ Wetland/Floodplainf <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) I—, ErosionCt3ntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> 2,880.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ♦ filling/access) <br /> 2,880.0 <br /> LI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ -+ ♦ $ 80,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes riNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des allo ['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? QYes ❑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) Dyes ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -4 <br /> 545-112(4/08) <br />