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La (-6 4 i i � I t c �r,c 5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jeff Ball ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 81 Fair Oak Road Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> (608)213-9068 jeffba1161@gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeff Ball ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 81 Fair Oak Road <br /> (City,State,Zip) (City.State,Zip) El Setbacks <br /> Deerfield, WI 53531 <br /> PHONE PHONE El Site Plan approval from <br /> (608) 213-9068 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeffba1161@gmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ['Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL G5 13.09 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Deerfield 24 1/4: SW %+/4: SE ❑ Driveway permits <br /> ADDRESS (state,county,town) <br /> 81 Fair Oak Road, Deerfield, WI <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 14,089 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> Storage building 4 j /` c c , -:,,e2 : �. l- ❑ Zoning District <br /> . 12 This project is a new building or structure. jet,V t ;�1t,1 LI Permitted Use? <br /> EIThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER rEPTIC (new/existing) <br /> HEI HT IN FEET: I NUMBER OF STORIES: (Not including basement) <br /> CL, I �Z 24.0 1.0 CI Wetland/Floodplain/ <br /> Y Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1STFLO.OR: ❑ ErosionControl permit <br /> 0.0 4 0 0 ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: l: filling/access) <br /> 0.0 0.0 ,,E � <br /> .. , ❑ Revi Jz •i . Survey <br /> ESTIMATED CONSTRUCTION COST: and B •17-ai :• o ions. <br /> (Please round to nearest dollar) -+ —* 'i "i $ 15,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes EINo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies ✓No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑No <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 ✓❑No ❑Don't know <br /> ❑ ✓N <br /> 7. Is this to correct a violation? Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► -+ <br /> 545-112(4/08) <br />