Laserfiche WebLink
SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Pete & Eileen Curtis ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number.Street,City.State.Zip) Deed Restriction; CSM <br /> 5586 Ralph Road,Oregon,WI 53575 <br /> Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (608)835-6555 1 pmcurtis55 @gmail.com <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden Meigs Inc. ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1527 Hwy 14,P.O.Box 412 1527 Hwy 14,P.O. Box 412 <br /> (City.State.Zip) (City.State.Zip) ❑Setbacks <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 767-4622 (608) 767-4622 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.ocm ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION fhttp://accessdauto.co.dano.wLual) <br /> PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE: ❑ Elevation of property <br /> ❑PARCEL 042/0509-164-66225-2 R-1 0.70 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Oregon 16 1/4: SE +/4+/4: SE ❑ Driveway permits <br /> ADDRESS: (state, county. town) <br /> 5586 Ralph Road, Oregon, WI 53575 <br /> C3LI: LOT SUBDIVISION BLOCKtor CI Sanitary permits <br /> 25 Hillcrest Heights (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 30'x 24'Accessory Building-Storage ❑ Zoning District <br /> . III 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 /> FIEWER I4EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 11.8 i 1.0 Li 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: ❑ ErosionControl permit <br /> 720.0 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND LOOK: 3RD FLOOR filling/access) <br /> "" <br /> 720.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available O tions. <br /> (Please round to nearest dollar) '♦ — -* -► $ 35,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des rdNo [Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes rANo [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes 4No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des JNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# t Co 51--) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes '4No ❑Don't know <br /> 7. Is this to correct a violation? [Yes IgNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —+ -► - <br /> 545-112(4108) <br />