Laserfiche WebLink
$ VA (.0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com FE=01:12=27 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Robert C. Jacobsen <br /> IS <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status; CUP; <br /> 2205 Town Hall Rd Mount Horeb, WI 53572 Deed Restriction; CSM <br /> HOME PHONE CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> (608)437-2205 (312) 953-4138 robjacobsen71@gmail.com <br /> 12 Site Plan drawn to scale <br /> AGENT INFORMATION <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Premier Building Solutions, Inc Premier Building Solutions <br /> AGENT ADDRESS 12 Site Plan including location <br /> CONTRACTOR ADDRESS of well/septic <br /> 2581 State Hwy 92 2581 State Hwy 92 <br /> (City,State,Zip) (City,State,Zip) 0 Setback <br /> Mount Horeb, WI 53572 Mount Horeb, Wi 53572 <br /> PHONE PHONE a Plan approval from <br /> (608) 437-9595 (608) 437-9595 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS Feet r.-5 <br /> jamesl @premierbuildingsolutions.biz jamesl @premierbuildingsolutions.biz 12 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE Q Elevation of property <br /> D PARCEL 054/0607-213-9250-0 fronts <br /> NUMBER A-1 5.08 frontage drawn to scale. <br /> TOWNSHIP: SECTIVRS' W `v w j <br /> • Springdale YY + : SW ,/4 : SW Li'(9riveway permits /le <br /> ADDRESS: (state ounty, town) <br /> 2205 Town Hall Rd Mt Horeb WI 53572 ACI1r+7 <br /> CSM LOT SUBDIVISION BLOCK/LOT anitary permits /v/y/ <br /> 10,447 1 NA NA (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> _STAFF REVIEW <br /> PROJECT DESCRIPTION: O r <br /> oniinn <br /> Construct new garage istrict <br /> Q This project is a new building or structure. der ed Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUMBER: RUraI <br /> EWER PEPTIC (new existing <br /> HEIGHT IN FEET / NUMBER OF STORIES: (Not including basement) <br /> la ' S" (11\—W w"\,. 1.0 i2 Wetland/Floodplain/ MA- <br /> ' <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: p EfOSIOnControl permit f 1 ,280.0 4, TOTAL SQUARE FOOTAGE: j (slopes, disturbance, J�/ <br /> 2ND FLOOR: 3RD FLOOR: filling/ cceSS) ��_ <br /> 1 ,280.0 <br /> evie Lo'ation Survey)\� <br /> ESTIMATED CONSTRUCTION COST: and ay. _•,: •• •• S <br /> (Please round to nearest dollar) ♦ -* -* -+ - ♦ $ 35 r 000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes IS DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes D✓No DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? D✓Yes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes is <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (I ave blank if none) <br /> 6. Is a location survey required? (see reverse) vs o DDon't know <br /> 7. Is this to correct a violation? Dyes ✓DNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -► -, <br />