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, ;1\164-1-14 CA/Cft <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> -Z.:01, ,. - <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PRO IDE <br /> OWNER NAME <br /> Kyle and Jamie Oarlock <br /> [✓ Zoning Status; CUP; 11, <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> O <br /> 308 W.Locust St.,Polo,IL 61064 Variance(# ) 1 <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS _�� <br /> (815)440-1706 Carlock@wmpj.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Steve Meier Meier Construction [✓ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic 14b Oc m <br /> 575 D'Onofrio Dr.,Suite 101 575 D'Onofrio Dr.,Suite 101 <br /> (City,State,Zip) (City,State,Zip) ✓O Setback./ <br /> Madison,WI 53719 Madison,WI 53719 <br /> PHONE PHONE ❑✓ SiteI �roval from <br /> (608) 469-7889 (608) 469-7889 appliatab ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> steve@meierc.com steve@meierc.com ❑✓ Floor plans to All( <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.c_o.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: -- ACREAGE: <br /> OPARCEL 0706-052-9601-0 F RA8 9.27 frontage drawn to scat . <br /> NUMBER C � <br /> TOWNSHIP: �Q/�'���!`" SECTION: ❑� Driveway permits <br /> jar--' <br /> Vermont��``^^�� 5 1/a; SE 1/a; NWADDRESS: • (state,county,town <br /> Cedar Hill Ln., Black Earth, WI 53515 ,�.�'. f <br /> '►�`""" O✓ Sanitary permits <br /> CSM: A 9-- <br /> - AT 1 1.% 7( 2 SUBI SUBDIVISION BLOCK/LOT (public,private) q dviy� <br /> PROPOSED PROJECT INFORMATION STAFF REyIEW <br /> PROJECT DESCRIPTION: f/ <br /> New Residential Home LI Zoning Di,�pICt <br /> 2 This project is a new building or structure. Li Permitte se? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC 13,202,100,156 Cy/existing) <br /> HEIGHT IN FEET:^ „we" NUMBER OF STORIES: (Not including basement) l� <br /> _!//� <br /> 2.0 LiWetlan F ori:?lain/ <br /> Shorel n (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: ❑ ErosionComtr permit <br /> 693.4 1 ,632.0 f + TOTAL SQUARE FOOTAGE: 4, (slopes,dis rbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1,486.9 3,118' ❑ Review .� on Survey <br /> ESTIMATED CONSTRUCTION COST: -► ♦ ♦ Q and av ' a)le options. <br /> -P(Please round to nearest dollar) $ 554,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? OYes O✓No ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? [fres ENo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? (=fres ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes O✓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) Oyes ENo [Don't know <br /> 7. Is this to correct a violation? Oyes O✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 -' .- <br /> REV(01/19) <br />