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a <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Andrew Goetz n Zoning S. tus; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7144 Kippley Rd. Sauk city WI 53583 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)250-9787 n Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Keaton Carey Keaton Carey n Site o:7 ..c1 .4.4. ; i' .,'.- -� <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel <br /> 223 W. Commerce St. 223 W. Commerce St. , dio t J <br /> (City,State,Zip) (City,State,Zip) ( ❑✓ Setbacks p. SSC]., .1 <br /> Mineral Point WI 53565 Mineral Point WI 53565 <br /> PHONE PHONE n Site Pla a p va om <br /> lk� <br /> (608) 574-4168 (608) 574-4168 applica o hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS r�� <br /> careycarpentry@gmail.com careycarpentry@gmail.com ✓❑ Floor plveto scale <br /> I", <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of petty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Ti PARCEL 050/0907-212-8200-4 SFR-08 0.75 1 frontage wn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Roxbury 21 1/4: NE 1/4: NW n Drivevypyb its <br /> ADDRESS: (S own) <br /> 7144 Kippley Rd. Sauk city WI 53583 <br /> ❑ <br /> ✓ Sanitary permits \ ) ;,(,j"s] <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) .�- 1 <br /> `73C11i ,; <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: t <br /> 24x20 Addition to East(back) side of exsiting home ❑ Zoning strict <br /> . ❑This project is a new building or structure. ❑ PermittlUse? <br /> nThis project is an addition/alteration to an existing building or structure. <br /> SANITARY S VICE: PERMIT NUMBER: ❑ Rural Addf��r- <br /> EWER �EPTIC (new/exi —' <br /> HEIGHT IN FE T: NUMBER OF STORIES: (Not including basement) ❑ Wetland/Floodplain/ <br /> 13.0 1.0 <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 n 1ST FLOOR: <br /> i,.0 440.o 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> Ff filling acc s) <br /> 2ND FLOOR: 3RD FLOOR: q <br /> !�V ❑ Revie L a Ion u1�7� <br /> (Please round to nearest dollar)ESTIATED CONSTRUCTIONCOST: ♦ -+ -+ --► $ 50'000.00 and iailable options. <br /> to r <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes nNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I—Yes I7No nDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes FIN <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 nNo nDon't know <br /> 7. Is this to correct a violation? [Yes nNo <br /> Il r o O ft `2 APPLICATION MUST BE SIGNED <br /> A (Continue on Back) -+ —► -+ <br /> REV(01/19) 4,„fi ,, J� eve D��L (� �/( 11 �_1 <br /> 6:xi-aumtJ {�cte�j /W" <br />