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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 /> Kevin Campbell <br /> Fl Zqtning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 507 8th st New glarus wi 53574 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)214-1613 kevincampbell50@gmail.com [] Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION pnd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jim Olsen E Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 'Setbacks <br /> PHONE PHONE [] Site Plan approval from <br /> (608) 220-7502 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESSf <br /> rivercityrealty@live.com Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 14p p y <br /> []PARCEL TBD RR-1 1.86 frontage drawn to scale. <br /> 'NUMBER <br /> TOWNSHIP: G 7'( '3,-2q � /(C't 'C t SECTION: .?.'..) <br /> springdale2 32 1/4:110 <br /> slet +A: ,9g/5et Driveway permits <br /> TBDADDRESS: (state, county,town) <br /> �- U �� Sanitapermits <br /> CSM: LOT SUBDIVISION LoctvLOT <br /> �2 A ry p <br /> iiS j .- r. (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: f k'4 _ <br /> building home (/N..) 1 �---.1ct�+'IAi- �' '`= '\ ❑ Zoning District <br /> • ❑✓ This project is a new building or structure. I <br /> ❑ Permitted Use? <br /> []This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li /Rural Address <br /> EWER EPTIC 1 C; ��( (( r//existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 20.9 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: p ❑ ErosionControl permit <br /> 2,188.0 3-,1 88.0 4, TOTAL SQUARE FOOTAGE: ,, (slopes, disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 7 fr-i <br /> --.-e <br /> . t. 3'1 �� J Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ 561 ,000.00 'C�lli 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? QYes nNo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? []Yes I No []Don'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? UYes nNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#11'674 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) []Yes nNo []Don't know <br /> 7. Is this to correct a violation? Yes []No <br /> 41 <br /> 1___L.r-tREE&-. `� APPLICATION MUST BE SIGNED <br /> REV(01/19) ( G ; <br /> /u (Continue on Back) -* -+ <br />