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�� - O <br /> ZONING PERMIT APPLICATION wwcoun�fdanecom SUPPLEMENT to Web App # <br /> • tf <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME \ntolec ,.�.j� <br /> ( Zoning Status;CUP; <br /> OWNER ADDRESS Number,Street,City,State,Zip) I Deed Restriction; CSM <br /> Kt"' iwy 14, Brooklyn, WI, 53521 Vari nce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 4u5-1384 ite Plan drawn to scale I <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> GENT NAME Cr1N.TRacToR NAMF �,� <br /> Walters Buildings 'Kyle Brueckner I to Site Plan including location <br /> AGENT ADDRESS •■ :1 •: :9 11: o well/septic <br /> P0 Box 388 553 Crestview Dr. 2b I <br /> (city,State,Zip) 0 Setbacks d <br /> lAllenton, WI 53002 Waterloo, WI 53594 PC'. <br /> PHONE PHONE ite Plan approval from <br /> 1-800-558-7800 (608) 512-9776 p• township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS vi Floor plans to scale <br /> KBrueckner@waltersbuildings.com p <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> PARCEL 26-0510-194-9660-0 ,'— ..2 �� frontage drawn to scale. <br /> NUMBER 1 <br /> TOWNSHIP: ��// SECTION: It•I DfIV2Way permits <br /> 44 IL. /' 1/4. S e 1%IA. 5f-- <br /> i <br /> ADDRESS: (state, county,town) <br /> 535 U.S. Hwy 14, Brooklyn, WI, 53521 Xnitary <br /> CSM: LOT SUBDIVISION BLOCK/LOT permits <br /> �� (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION Main Building 16'x20 with 16'x20' Lean-to attached <br /> Zoning District <br /> _1 This project is a new buil g or structure. rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ri 'Ural Address <br /> ❑SEWER ❑SEPTIC (new/existing) <br /> HFIGHT IN FFFT NUMBER OF STORIES: (Not including basement) <br /> 12' to soffet, 16' over all 1 story etland/F000dplain/ <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: 1ST FLOOR: <br /> rosionControl permit <br /> NA 640 SqFt 4,, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: NA 3RD FLOOR: NA I 640 SqFt <br /> 411 -eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 23,150 and available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes AilNo on't knovac` <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes r No <br /> 3. Have you talked with the township about your project and are they in agreement? �DYes 'Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ,�I: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 /> 7. Is this to correct a violation? ❑Yes UNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ■ -♦ <br /> 545-112(4/08) <br />