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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 /> Jon E. Holtzman n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3217 HWY 134 CAMBRIDGE WI 53523 Variance(# '4,742 ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)423-3436 (608)216-4082 jholtzm@frontier.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> London Lumber Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 34 Depot Rd <br /> (City,State,Zip) (City,State,Zip) ❑✓ Setbacks <br /> Cambridge WI 53523 <br /> PHONE PHONE 0 Site Plan approval from <br /> (608) 764-5222 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.whusl) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 024/0712-364-9050-0 RR-1 1.97 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Deerfield 36 1/4; SE 1/41/4; SW ❑✓ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 3217 HWY 134 CAMBRIDGE WI 53523 <br /> CSM: 14,742 LOT 1 SUBDIVISION BLOCK/LOT Z Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> BARN RENOVATION INTO DWELLING DCPZP-2018-00052 EXPIRED ❑ Zoning District <br /> . ❑This project is a new building or structure. Cl Permitted Use? <br /> ❑✓ This project is an addition/alteration to an existing building or structure. <br /> p <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 1 3,201,BOO,O20 (new/existing) <br /> g) <br /> HEIGHT IN FEET: 40 0 NUMBER OF STORIES: (Nottincluding basement) ❑ Wetland/Floodplain/ <br /> 29' MEAN 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 /> 1 ,800.0 1 ,824.0 4, TOTAL SQUARE FOOTAGE: 1, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 1 ,626.0 3RD FLOOR: 5,250.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -+ .- ♦ .- 575.00 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? Eves ❑✓No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lives Do EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [fres ❑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 No ❑Don't know <br /> 7. Is this to correct a violation? Lives 0No <br /> DCPZP-2018-00052 EXPIRED APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -i -o- <br /> 545-112 <br /> ►545-112(4/08) <br />