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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME JONATHAN LOTHE <br /> ning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State.Zip) Deed Restriction; CSM <br /> 176 E ROCKDALE RD,CAMBRIDGE,WI 53523 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 000-0000 (608)235-9447 JLOTHE4 @YAHOO.COM Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> TBD as<iie Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE Ite Plan approval from <br /> applicable township. *- <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) (evation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Wi PARCEL 061224296800 Al-EX 5.04 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> CHRISTIANA 24 1/: .S(,) 1/4'/a: N F riveway permits ,/ <br /> ADDRESS: — (state, county,town) A <br /> 176 E ROCKDALE RD CAMBRIDGE WI 53523 <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits Q/( <br /> 10,009 1 (public, private) J(y# <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: -, '� <br /> ACCESSORY BUILDING 4$ ' <br /> ) 3 a Sb ra 1�1' Zoning District <br /> . NIThis 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: --E r�uralAddr- s <br /> DEWER nEPTIC (new/; isttng <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) -c <br /> 1-7 1.0 t=(Wettand/Ftoodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachmen#), <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> rosionControl permit No <br /> BASEMENT: 1ST FLOOR. <br /> 1 ,536.0 I TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: ♦ f lling/access) <br /> 1 ,536.0 Review Location Survey IV/4 <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ $ 23,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives NINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Elves NINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes '4No <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 MNo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> / s5` c ° (Continue on Back)APPLICATION MUST BE SIGNED <br /> 545-112 lary 4/1 al /`(„J <br />