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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU;TOMER TO PROVIDE <br /> OWNER NAME <br /> Steven Somerfeld <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status; CUP; <br /> Deed Restriction; CSM <br /> 495 Hillcrest Lane Brooklyn,WI 53521 (Town of Oregon) Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)333-6352 steve.somerfeld @gmail.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> IN Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) ' (City,State,Zip) 51 Setbacks <br /> PHONE PHONE ❑ to Plan approval from <br /> pplica ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) p <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ii/ Elevation of property <br /> ❑PARCEL 042/0509-272-4668-0 RH-1 DCPREZ-0000-06120 2.72 frontage drawn to s le. <br /> NUMBER '.� <br /> TOWNSHIP: SECTION: <br /> Oregon 27 '/a: NW 141/4: SW ❑ Drivew ermits <br /> ADDRESS: (S county,town) <br /> 495 Hillcrest Lane Broolyn, WI 53521 <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> El Sanita rmits <br /> 38 (pu . , private) <br /> PROPOSED PROJECT INFORMATION Mfg REVIEW <br /> PROJECT DESCRIPTION: <br /> 12'x 24'Deck addition to the west end of the house sing District <br /> . ❑This project is a new building or structure. Permitted Use? <br /> FA This project is an addition/alteration to an existing building or struct e. <br /> SANITARY SERVICE: PERMIT NUMBER: 1 Li Rural .,A - <br /> fnewI '- i <br /> EWER �EPTIC �I J. ( <br /> HEIGHT IN FEET: \... NUMBER OF STORIES: (Not inc uding asement) <br /> ❑ Wetland/F alit/ <br /> AREA TO NEAREST SQUARE FOOT: SI10reI (attachment) <br /> (Outside dimensions including unfinished area, attac garages and above grade decks or porches) ❑ <br /> BASEMENT: 1ST FLOOR . 2 ` E IonCon permit <br /> TOTAL SQUARE FOOTAGE: ,, (slopes,d :. ,- nce, <br /> 2ND FLOOR: 3RD FLOOR: filling/ «` )f <br /> 288.0 <br /> ❑ - - '- Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -. "+ ♦ "* -+ ♦ $ 3,000.00 <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 a o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes aka <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ININo <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 JNo ❑Don't know <br /> 7. Is this to correct a violation? :Yes '4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -♦ <br /> 545-112(4/08) <br />