Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Darell and Kathy Loy <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 950 Silver Ripple Way Deforest Wi 53532 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 843-8734 n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Rick French Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5864 County Road TT <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Marshall Wi 53559 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (608) 843-8735 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> gochancejake@yahoo.com n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 111 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> rII I PARCEL 081208391110 SFR-08 1.14 frontage drawn to scale. <br /> (NUMBER <br /> TOWNSHIP: SECTION: <br /> Medina 1/4. 1/4: ❑ Driveway permits <br /> ADDRESS: (state,county,town) <br /> 5864 Couty Road TT Marshall Wi. 53559 <br /> CSM: LOT SUBDIVISION BLOCK/LOT n Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 18 x 25 metal garage ❑ Zoning District <br /> rf 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 f J EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 10.3 1.0 ❑ 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 /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 450.0 <br /> 4TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 450.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ 13 000.00 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? Lilies I No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? f—Yes FiNo nDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓fres FINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? _Yes 171N <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) f—Yes fNo 1-1Don't know <br /> 7. Is this to correct a violation? Yes flNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) - --0 -4 <br /> REV(01/19) <br />