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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> David Casimir <br /> OWNER ADDRESS (Number;Street.City.State.Zip) ❑ZOnI US; CUP; <br /> 4197 Barlow Rd Cross Plains,WI 53528 Deed StriCtlOn; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)662-1277 (608)662-1277 dacasimir @casimirjones.com <br /> ❑Site Plan raw to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden Meigs Inc-Dave Budden ❑Site Plap In ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well! tic <br /> 1527 Hwy 14,P.O.Box 412 1527 Hwy 14,P.O.Box 412 <br /> (City,State.Zip) (City,State,Zip) ❑Set (g <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> PHONE PHONE <br /> (608) 767-2729 (608) 767-2729 ❑applica.'e •■rn • m <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.com ❑Floor plan to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation o Ooperty <br /> ❑ <br /> NUMBER 020/0707-171-9561-0 RH-4 27.90 frontagtawn to scale. <br /> TOWNSHIP: SECTION: <br /> • Cross Plains 17 1/4: NE WA: NE ❑Drivew its <br /> ADDRESS: (state, II , own) <br /> 4197 Barlow Rd Cross Plains, WI 53528 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sa t tS <br /> 7,349 1 (py ri ate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Personal Storage Building ❑ Zonink Djg6ct <br /> This project is a new building or structure. ❑ Perm se? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuralAdd -ss <br /> EWER [)EPTIC (new/, g) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ' <br /> 17.3 1.0 ❑ Wei.- - •i ;•-'...in/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shor 'hme t)�_y�-��[,y <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Cam(/ / <br /> BASEMENT 1ST FLOOR: ❑ Eros,•- Oli��•lpei <br /> 3,200.0 + TOTAL SQUARE FOOTAGE: + (S10•'- , r • ►� <br /> 2ND FLOOR: 3RD FLOOR: <br /> fill' : -�: ' <br /> 3,200.0 ❑ Revi_ `t. urvey <br /> ESTIMATED CONSTRUCTION COST: i ♦ and a - - , •tions. <br /> - <br /> (Please round to nearest dollar) $ 85,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes alo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes DVo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? [Yes E s o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes EJVo <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 a10 ODon't know <br /> 7. Is this to correct a violation? ❑Yes ✓iNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ -+ -+ <br />