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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 /> Jeff and Kathy NewmanEl Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 4288 South Jordan Dr. McFarland,WI 53558 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6059'5/67 97 G?S'-$/6' 7y3w 17A11C 6ilU(6• eC', dJ C7 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NA CONTRACTOR NAME <br /> beet ,s, //?r-f/!!r9r �c2.0mailc y D Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 6 9(i ti2.tf// Q7'. 66 y C-4144/.&// St. <br /> (City, e,Zip), (City,Stat2,Zip) Setbacks <br /> 7// l/Xv,r /4 r31// 6el so e, /,Z .3-,N1 <br /> PHONEPHONE ❑Site Plan approval from <br /> 6032")5'J---/53/ 6°S )' y—' /s--3/ applicable township. <br /> E-MAIL ADDRE SE-MAIL ADDRESS <br /> fobei bear/ 4Pedtrey/4 /0i f1C Co ni 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpalaccessdane.co.dene.wi.us!) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: o ACREAGE: Ill <br /> 0 NUMBER 0 610-03 -5/27.--0 <br /> t SIR -08 0 , 11 frontage drawn to scale. <br /> TOWNSHIP: /� SECTION: <br /> ID 's 0 12u i n y,: S E 1/4. 8 ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: A/ <br /> 11 /� ,�/� _ <br /> 7 Z 38 „So c.t"j J&/'CIart Ptd t.fd4it (,(�`f 535.5 Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> /. 5 J ' (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> real ad 1tION� �i/'i't (�',4j'fG(s'G��Prnt')new S, fp rc'of k' /./t ❑ Zoning District <br /> . ❑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 FTEPTIC (new/existing) <br /> HEIGHT IN FEET: ) t it NUMBER OF STORIES: (Not including basement) <br /> L ❑ 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 /> ❑ ErosionControl permit <br /> BASEMENT: /0 it S 1ST FLOOR:/V20� 1 TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> ♦ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2 2- 3T 2 3585f0.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> -4. ♦ $ <br /> (Please round to nearest dollar) 900 d©o <br /> , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes Ejl\lo LDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies a. ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes Dlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Elves 5—(1No <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 ENo (Don't know <br /> 7. Is this to correct a violation? Dies 4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) --► -4 -* <br /> REV( 1'19) <br />