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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 /> Gerald & Tamara Pooch iZoning Status;CUP; A —16c <br /> OWNER ADDRESS (Number,Street,City,State,Zap) Deed Restriction;CSM <br /> 656 Koshkonong Road Cambridge WI 53523 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)423-3374 (608)628-1281 n/a Site Plan drawn to scale A. e <br /> AGENT INFORMATION !CONTRACTOR INFORMATION and includes dimensions /'�`tJ-�(-- <br /> AGENT NAME CONTRACTOR NAME <br /> Bowers Construction Inc Site Plan including location n`-4 <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 505 Cottage Grove Road /5' <br /> (City,State,Zp) (City,State,Zip) Setbacks V2-14/..5-0 <br /> Madison WI 53716 <br /> PHONE PHONE (mite Plan approval from f/f. <br /> (608) 221-2272 applicable township. Ay <br /> fit- <br /> ADDRESS E-MAIL ADDRESS <br /> kenbowers5108@vahoo.com ,Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Ai <br /> PARENT PARCE NUMBER: }�7�y CURR T ZONIN • ACREAGE: Elevation of property <br /> El PARCEL NUMBER ,11 G o b I Z—!"53—66W 3 N `C V© frontage drawn to scale. <br /> TOWNSHIP: SECTIO <br /> Christiana ( %: WA: A F ,k Driveway permit <br /> ADDRESS: (state,county o <br /> 656 Koshkonong Road <br /> CSM: LOT SUBDIVISION BLOCK/LOT 41 Sanita .yI its <br /> e-- __ (public, > � <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / / t 4-1 f -Jt <br /> Covered porch (0 1 - x ( 2 pe / 2 JKoning Dist'ct <br /> . ['This project is a new building or structure. Permitted se J / (1 ( aOO'∎ <br /> IN This project is an addition/alteration to an existing building or structure. / C'/:k <br /> SANITARY SERVICE: �,�/ PERMIT NUMBER: (/LI'R -I Address <br /> EWER gEPTIC �_ xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES:(N including basement) ,. plain/ <br /> . 1 OOd <br /> or- and attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> rosionCOntrol permit <br /> 480.0 , TOTAL SQUARE FOOTAGE: , (slopes,disturbance, I <br /> BASEMENT: 1ST FLOOR: i <br /> 2ND FLOOR: 3RD FLOOR: filling/access) 44 t� <br /> 480.0 eview Location Survey <br /> I <br /> ESTIMATED CONSTRUCTION COST: and available options. „ 4_. <br /> (Please round to nearest dollar) ♦ ♦ --► ♦ ♦ ♦ $ 9,600.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? JYes JVo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes go ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Dslo <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) QYes alo Eon't know <br /> 7. Is this to correct a violation? QYes alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />