Laserfiche WebLink
SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Claudia Nehring <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 10455 Sutcliffe Rd Black Earth WI 53515 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)767-2196 (608)609-3608 claudianehringl1 @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Recreational Concepts Inc ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 121 N Main St <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Oregon WI 53575 <br /> PHONE PHONE ' ❑Site Plan approval from <br /> (608) 835-2780 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> recconinc @ymail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL 006/0806-332-9773-9 RH3 9.49 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Black Earth 1/4: 1/4'/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 10455 Sutcliffe Rd Black Earth <br /> CSM: 7 959 LOT 3 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION:15'x 30'above ground pool (ôv.&t....') CI Zoning District <br /> This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑ Wetlarld/FloodptalN <br /> AREA TO NEAREST SQUARE FOOT: ShOreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ErosionCOntrol permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: 1, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 59 9 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -0. ♦ $ nd available options. <br /> -ii. -b.(Please round to nearest dollar) co O0` Q <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes laGo ❑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? QYes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ow <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 ONo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ -i <br /> 545-112(4/08) <br />