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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 /> Gregory Baker gloning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City.State,Zip) Deed Restriction; CSM <br /> 9514 Blackberry Rd,Black Earth,WI 53515 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> I&OW 761-4148 stephenmcnutt@gmail.com <br /> El-Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden-Meigs Inc. Dave Budden-Meigs Inc. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic iti 4, <br /> 1527 Hwy 14,P.O.Box 412 1527 Hwy 14,P.O.Box 412 <br /> (City,State,Zip) (City.State,Zip) R'Setbacks <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> PHONE PHONE El'gite Plan approval from <br /> (608) 767-4622 (608) 767-4622 applicable township. N\'4' <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.com Q'rloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) [ levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 006/0806-251-8400-0 RH-2 4.50 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Black Earth 25 1,4. SE 1A4: NE riveway permits <br /> ADDRESS: (state,county,town) �1 <br /> 9514 Blackberry Rd, Black Earth, WI 53515 <br /> CSM: LOT SUBDIVISION BLOCK/LOT C-i'�anitary permits nn <br /> 10,257 2 (public,private) ,N'Ar <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: �� <br /> Storage Building rJ Zoning District <br /> . 151This project is a new building or structure. Er-Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. gyp/ <br /> SANITARY SERVICE: PERMIT NUMBER: Ei I'CuralAd e s <br /> EWER r)EPTIC (new/ sti <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 14.1 1.0 Wetland/Floodplain/ Np' <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> rosionControl permit A' <br /> BASEMENT: 1ST FLOOR: /" <br /> 1 ,470.0 j, TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 1 ,470.0 �,/ <br /> ly Review Location Survey Ai Pt- <br /> ESTIMATED CONSTRUCTION COST: and available o tions. <br /> (Please round to nearest dollar) ♦ -* ♦ ♦ ♦ $ 25,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes DNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes alo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes OW <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ONO <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 ?Vo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes EINo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -i - <br />