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ZONING PERMIT APPLICATION wcountyofdane.com SUPPLEMENT to Web-App # <br /> ww. <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jennifer Goemans <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1934 Hubred Ln. Deerfield WI 53531 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)576-1947 jennifer.goemans@gmail.com E Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Patrick Ceithamer Silver Stone Builders LLC E Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4422 American way 4422 American way <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Cottage Grove WI 53527 Cottage Grove WI 53527 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 209-1927 (608) 839-8311 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> pat@silverstoneLLC.com Pat@silverstoneLLC.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 071123487850 RR-2 2.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Deerfield 23 1/4: NW 1/4: SE ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> 1934 Hubred In. Deerfield WI. 53531 <br /> ['Sanitary permits <br /> CSM:14593 LOT 1 SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Addition to deck Zoning District <br /> ❑This project is a new building or structure. ci Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: VIP Rural Address EX <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 7 V Wetland/Floodplain/ NO <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: ErosionControlVI permit <br /> 580.0 4, TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, NO <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 580.0 <br /> Vi Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ 50,000 and available options. NO <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? Elves E✓No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies :✓No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? E✓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) Elves ❑✓No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ['No <br /> $1 08.00 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ —► <br /> REV(01/19) <br />