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SUPPLEMENT to Web-App# <br /> ZONING PERIVIT APPLJCA110N vwwtoounty�afdaneoom <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Dianna & Ryan Stace <br /> El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 4733 W Rutland Rd. Brooklyn, WI 53521 Variance(# ) <br /> HOME PHONE D(pnYict I CELL PHONE gysfh E-MAIL ADDRESS <br /> 608-516-8025 508-469-1791 drstace @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Helmer Construction ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 151 W Grove St <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Oregon, wi 53575 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 577-7041 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑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 /> IZI PARCEL 052/0510-303-8510-0 RH-1 2.18 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION. <br /> Rutland 30 1/4: NW '/1/: SW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4733 W Rutland Rd. Brooklyn, WI 53521 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 10486 1 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> New Deck (screened in with roof) U Zoning , <br /> . ZThis project is a new building or structure. U Us D? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER. 0 FuralAddres <br /> EWER SEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 8' 1 U We r� <br /> AREA TO NEAREST SQUARE FOOT: �fB( -:' I€� § <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) o -i <br /> L� Eros, <br /> BASEMENT: 1ST FLOOR: 4, TOTAL SQUARE FOOTAGE: 4, (slopes, <br /> filling/access) J, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 250 - <br /> 'Q ReviewLocattonSurvey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ arrd avail cpt s <br /> (Please round to nearest dollar) $ 7,500 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ZINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes mNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ZYes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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 ZNo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Ilo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />