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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 /> Chester A Isaacson <br /> ri Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 9220 Fargo Road, Mount Horeb,WI 53572 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)695-9760 (608)695-9760 chesterisaacson@yahoo.com n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> I am building the deck myself ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) n Setbacks <br /> PHONE PHONE n Site Plan approval from <br /> applicble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ti Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: 7 -••cREAGE: 0Elevation of property <br /> Ti PARCEL 054/0607-292-8650-0 -Residential N" 9.10 frontage drawn to scale. <br /> I (NUMBER <br /> TOWNSHIP: SECTION: <br /> Springdale i 4 4 1/: /\J v\j 1/ A/ 1\., 0 Driveway permits <br /> ADDRESS: (state;county,town) <br /> 9220 Fargo Road, Mount Horeb, WI 53572 <br /> CSM: LOT SUBDIVISION BLOCK/LOT Ti Sanitary pefmits <br /> 5,839 2 Lot 2 (public, private) <br /> PROPOSED PROJECT INFORMATION ,' STAFF REVIEW <br /> PROJECT DESCRIPTION: I / � <br /> I am building a covered deck on the back of my house. t 1 X Cj C�r�it ld/Zoning District <br /> • nThis project is a new building or structure. [1 <br /> // <br /> ly'Permitted Use? <br /> nThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> EWER /3EPTIC (n /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '� <br /> 12.0 1.0 ❑ Wetland/Floodplain/ ilTh <br /> Shoreland (attachm0)L, <br /> AREA TO NEAREST SQUARE FOOT: �,o t <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionControl permit <br /> 328.0 j TOTAL SQUARE FOOTAGE: 1 (stde,,s disturbance, ) Vsei <br /> 2ND FLOOR: 3RD FLOOR: filling/access) / <br /> 328.0 I ' <br /> Review Location Survey , <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -► ♦ ♦ ♦ --i► -► $ 6,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies nNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes T]No nDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑✓ No <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 FNo fDon't know <br /> 7. Is this to correct a violation? nYes ❑✓ No <br /> APPLICATION MUST BE SIGNED <br /> (Z (Continue on Back) -► -♦ -► <br /> REV(01/19) <br />