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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Wi DNR <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning rusi CUP; <br /> PO BOX 7921 MADISON WI 53701-7921 Deed Reeststriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 0 Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Chris James,Dane County Land and Water Resources Advanced Building Corp 850911 151 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5201 Fen Oak Dr 3624 Pioneer Road <br /> / <br /> (city,state,Zip) (City,State,Zip) 0 Setbacks <br /> Madison WI 53718 Verona,Wi 53593 <br /> PHONE <br /> ❑Site Plan approval from <br /> (608) 224-3730 PHONE (608) 833-0900 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> James@countyofdane.com 4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑PARCEL 0710-323-8000-9 RE-1 131.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑Driveway permits <br /> Blooming Grove 32 1/4: NW 1/41/4: SW <br /> ADDRESS: (state,county,town) <br /> 4401 Libby Rd, Madison WI 53701-7921 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVI <br /> PROJECT DESCRIPTION: <br /> Dane County Parks is proposing to build a metal park storage building U Zoning District <br /> . FA This project is a new building or structure. <br /> 1::J Permitted-Use? �. <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> Rural dress <br /> EWER IEPTIC (new/existtng <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 26.0 1.0 0 Wetland/Floodplainl , <br /> Sh oreland (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: rosionuontrO(permrt <br /> 11,734.0 4, TOTAL SQUARE FOOTAGE: 4, ,(slopes,C istu an <br /> rbce, <br /> 2ND FLOOR: 3RD FLOOR: !`IlltlOSS� <br /> 11,734.0 . <br /> 0 Review Location Survey, -: <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ --► ♦ ♦ ♦ ar)d a Otabie Options <br /> (Please round to nearest dollar) , 600,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes IN ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes �No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes M No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#1p732 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes ON° ❑Don't know <br /> 7. Is this to correct a violation? QYes ✓QNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -+ —► <br /> 545-112(4108) <br />