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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CU..TOMER TO PROVIDE <br /> OWNER NAME <br /> Chad M Gray, Laura C Gray <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> ed Restriction; CSM <br /> 375 Hannerville Rd., Edgerton,WI,53534 <br /> ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)873-1681 (608)576-3565 slydr1 @msn.com ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑ .it Ian a oval from <br /> p li township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> g F or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dtane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0511-263-8000-4 A-1 Ex Exclusive Ag District 40.10 frontage drawn to ale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunkirk 26 1/4: SW 1/4+/: NE ❑Dri Sway rmits <br /> ADDRESS: ( ate, linty,town) <br /> 375 Hannerville Rd <br /> CSM: LOT SUBDMSION BLOCK/LOT a tary permits (,.. r II <br /> :ublic, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 1 i <br /> o ht\' ._ ,. j LI 0 ,oning District <br /> . ❑This project is a new building or structure. • Permitt se. <br /> 0 This project is an addition/alteration to an existing building or structure.L SANITARY SERVICE: PERMIT NUMBER: Li Rural ddress <br /> EWER PIEPTIC �- \i (new/e 'stin <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> t"t'e:'e- 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachmen) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BAS ENT: 1ST FLOOR: CI c ( �- l u (:) + TOTAL SQUARE FOOTAGE: i (slopes,disturbance, <br /> D FLOOR: 3RD FLOOR: / filling/access)a8, 02 -2744-141- <br /> ❑ Review Location Survey n <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) '♦ ♦ ♦ .- .- ♦ $ 2 1 0,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? No -s 0 . ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ►�/) -s op, o FDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? L es ✓]10 <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes a <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 E4o ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓No <br /> --ki D Li 14 0 APPLICATION MUST BE SIGNED <br /> i . (Continue on Back) -1 -+ <br /> 545-112(4/08) <br />