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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> David Becka ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 6705 Village Park Drive Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)334-7975 (608)334-7975 dbecka57 @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> David Eisenga Heckaman Homes ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> WI975 County Road G 2676 East Market Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Fall River Nappanee, IN <br /> PHONE El(608) 697-3769 PHONE (574) 773-4167 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> stilbest @hotmail.com stilbest @hotmail.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 080629383300 RH-4 16.93 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Black Earth 29 1/4: 08N %/a IA: 06E/W ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> ion 11. L1 Fesenfeld Road ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 13;961 1 None None (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3e2 ' - Lf O' 74- c ';- , ,S l/,.z Q ❑ Zoning District <br /> . IN This 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: ❑ Rural Address <br /> EWER [)EPTIC 13-20g -o ,('j l' _ (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> t <br /> 1 S 1.0 ❑ Wetland/Floodplain/ <br /> ' Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: �srFLOOr: ❑ ErosionControl permit <br /> 1 00 4, TOTAL SQUARE FOOTAGE: y (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 660 3RD FLOOR: <br /> 0.0 st Y (200 0.0 l_ aV ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available o dons. <br /> (Please round to nearest dollar) '♦ -+ -+ .. ♦ ♦ $^5,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓�lo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ✓❑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 MI 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 /> 7. Is this to correct a violation? ❑Yes is No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ♦ - <br /> 545-112(aioe) <br />