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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME JDC PROPERTIES, LLC <br /> Ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 263 RODNEY RD, CAMBRIDGE, WI 53523 Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> (608)212 4480 ' JCTRANS84 @YAHOO.COM Si Plan drawn to scale <br /> AGENT INFORMATION j CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME i CONTRACTOR NAME <br /> 1 ❑Site la • cluding location <br /> GENT ADDRESS CONTRACTOR ADDRESS of we eptic <br /> (City,State,Zip) (City,State,Zip) Set k5- <br /> PHONE PHONE ite Plan .:proval from <br /> appli.r• e township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor p.: s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: r • evation of property <br /> ❑PARCEL C2 6.00 frontage d wn to scale. <br /> NUMBER 0 CY). q)3 s6•aU <br /> TOWNSHIP: SECTION: <br /> CHRISTIANA /,. 1/41/4. ❑ Drive permits <br /> • <br /> ADDRESS: (s e,c unty,town) <br /> 263 RODNEY RD, CAMBRIDGE, WI 53523 <br /> CSM: 11 614 LOT 2 SUBDIVISION BLOCK/LOT ❑Sa Mary rivate s <br /> (pub -,private) <br /> PROPOSED PROJECT INFORMATION TA REVIEW <br /> PROJECT DESCRIPTION: <br /> � ' ..Sr.S oni g District <br /> . ElThis project is a new building or structure. ermitted Use? <br /> Isi This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: ��-L PERMIT NUMBER: ❑ Rural Ad <br /> 7 <br /> FIEWER 1�6EPTIC (ne Is wig <br /> HEIGHT IN FEET: 1 NUMBER OF S 1E7 (Not including basement) <br /> /' —7' CI Wetlan• - �••• ain/ <br /> / Shor- . • (a ..chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion..• ro permit <br /> 9 e c,�C / j, TOTAL SQUARE FOOTAGE: j. (sic).- ,dis . bance, <br /> `r G1 / fi Ing/access) <br /> 2ND FLOOR: 3RD FLOO : <br /> 9 Li Revi-• Local-,.urvey <br /> ESTIMATED CONSTRUCTION COST: ♦ —i. -► -► f w and avai -.7.1e options. <br /> (Please round to nearest dollar) / C.-) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes fNo ['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? ❑Yes ❑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) ❑Yes ❑No ODon't know <br /> 7. Is this to correct a violation? DYes isiNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* ■ —► <br /> 545-112(4/08) <br />