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` ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Richard A. Fizzell IfZo1ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D ed Restriction; CSM <br /> 895 Storytown Rd Brooklyn WI 53521 V�riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS i <br /> (608)334-0943 Blacksmith @prairieartmetal.com ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION land includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Self El ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE ❑Site Pla pproval from <br /> 16prlica le township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> Fl or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) e levation of ro <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P <br /> ❑PARCEL ` agz38ppp, Ag1 EX 47.00 frontage drawn scale. <br /> NUMBER �� ♦, y - „, <br /> TOWNSHIP: • `' ••••, SECTION: __ <br /> • Oregon 17 . : �e`� %4%4: SW <br /> ❑ Drivewa ermits <br /> ADDRESS: (state, ounty •wn) <br /> 895 Storytown Rd <br /> ❑Sanita •ermits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (i ubli•, private) <br /> PROPOSED PROJECT INFORMATION $ AFF REVIEW <br /> PROJECT DESCRIPTIv N: <br /> Addition 1 /`(,Yo 'o ing District <br /> . ❑This project is a new building or structure. ❑ Permi -d U--? <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ ural A'dress <br /> FIEWER [EPTIC ewle -ting) ` <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> etland/Floodplain/ <br /> horelarid (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> ErosionContral permit <br /> 320.0 (slopes disturbance,i , <br /> fllng amass) <br /> 2ND FLOOR: 3RD FLOOR: s <br /> 320.0 ❑ Review Location Survey 1�\ <br /> ESTIMATED CONSTRUCTION COST: atd available o Lions. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 10,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es gpis, ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? DYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ENo <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 NI No <br /> 74 .. " . P APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) — 4 <br /> ( S o ^ S 1 r <br /> (� ► ♦ — <br /> ti � <br />