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c5-ik <br /> 44, ic <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Paul Kjorlie ❑Zoning t s; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed R triction; CSM <br /> 3725 Shiloh Road DeForest, WI 53532 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)228-4568 (608)438-7432 pkjorlie @charter.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includkydimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Paul Kjorlie Paul Kjorlie n Site Plan i cl ng location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/sep <br /> 3725 Shiloh Road 3725 Shiloh Road <br /> (City,State,Zip) (City,State,Zip) ❑Setbaks <br /> DeForest WI 53532 DeForest WI 53532 <br /> PHONE PHONE ❑Site Pla alp I from <br /> (608) 438-7432 (608) 438-7432 applica"I ' hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> pkjorlie @charter.net pkjorlie @charter.net ❑Floor plans to Cale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 081003402056 R1 DCPREZ000001706 0.52 frontage drai0 to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: DrlveW ItS <br /> TO8NR1OE 3 1/4: NE 1/4l/4: SE 0(state,' o t wn) <br /> ADDRESS 3725 Shiloh Road DeForest, WI 53532 <br /> ❑Sanitary permits ` J '4--CSM: LOT 45 SUBDIVISION BLOCK/LOT <br /> (public, private) C 1W{C(,c <br /> Stony Ridge <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,,11 <br /> Attached 2 car garage IVQ best i A_,1 ire.M0/ `e( ❑ Zonin strict <br /> . <br /> This project is a new building or structure. <br /> ❑ PermittWse? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuralAddr ss <br /> EWER [EPTIC (new/exi ttri ) <br /> HEIGHT IN FEET: kr; - ` NUMBER OF STORIES: (Not including basement) <br /> C E(\ 1.0 ❑ Wetlan F o plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorement) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: • ❑ Erosiogrr&Germit <br /> q�P�- 4, TOTAL SQUARE FOOTAGE: 4, (slope l t •- ce, <br /> 2ND FLOOR: 3RD FLOOR: ( (�j;�j filling/access) <br /> v ❑ Revie L ion Survey <br /> ESTIMATED CONSTRUCTION COST: and a ptions. <br /> (Please round to nearest dollar) ♦ —' ♦ ♦ $ 25,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes '4No ❑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 EINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes MINo <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 ig No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes is <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -+ <br /> 545-112(4/08) <br />