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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME WARREN GASKILL <br /> Zon' Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D Restriction; CSM <br /> 10405 BELL RD, BLACK EARTH WI, 53515 ariance # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6087673642 6087673642 WGASKILL @RAPID-IMPROVEMENT.COM ' Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> a <br /> itil egr cea er igefterEWorld LLC Sit n including location <br /> tilr an Dr c1130 Ireland r of well/septic <br /> Ied <br /> ,Slate, ( State,Z' )aunakee, WI 53597 '�'aunaKCee, WI 53597 <br /> PHONE 6084443749 PHONE 6084443749 ❑Site proval from <br /> appli township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tirndyer1@gmail.com tirnclyer1@gmail.com El Floo to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.ciane.wi.us/) <br /> PARENT PARCEL NUMBER CU ENT ONING: ACREAGE: El ation f property <br /> PARCEL 070616192108 (,1 G ontage drawn to sca le. <br /> le. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Town of Vermont ,/4: ,/,/: El Drivewa permits <br /> ADDRESS: (state ounty,town) <br /> 10405 BELL RD, BLACK EARTH, WI 53515 <br /> CSM: LOT SUBDIVISION BLOCK/LOT El San'�-ry -rmits <br /> III (pub'. ,'.rivate) <br /> PROPOSED PROJECT INFORMATION /STAFF REVIEW <br /> PROJECT DESC N: <br /> () pi' f gl'',7-__ CCP vL P 1,..112 ,0 Waning District <br /> . <br /> This project is a new building or structure. / P fitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ' ❑ /Rural A••,-/...4 EWER el EPTIC it / (new misting <br /> HEIGHT IN FEET: 10 FT NUMBER OF STORR((E� (Not including basement) <br /> ?: ❑ Wetla +II,• plain/ <br /> Shore . attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FL R: ❑ Eros'.,L •' trol permit <br /> (� 3 TOTAL SQUARE FOOTAGE: 3 SI•' - , 'isturbance, <br /> filling/acc- ) <br /> 2ND FLOOR: 3RD FLOOR: 302 <br /> ❑ R Jew cation Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 21,000 and Iia fie options. <br /> (Please round to nearest dollar) S 71,,:c <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? IJYes J.lo �on't kn <br /> 2. Is there a wetland or floodplain on or near the property? Dies o Ion't know <br /> 3. Have you talked with the township about your project and are they in agreement'? EYes to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? lYes ao <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) Ekes o Jon't know <br /> 7. Is this to correct a violation? :Yes Jlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />