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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 /> David and Patricia Voigt _— ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 111 West Garden Ave.Palatine IL 60067 <br /> HOME PHONE CELL PHONE ! Variance(# <br /> E-MAILADDRESS <br /> (847)934-7213 (224)629-6861 I dave@dlvoigt.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Owner(Self) ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> Same <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdano.co.deno.whusi) ID Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE <br /> ❑PARCEL frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Albion <br /> 1/4: +/4+/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 112 Potowatomi Drive Edgerton WI 53534 <br /> CSM' LOT SUBDIVISION BLOCWLOT ❑Sanitary permits <br /> Indian Heights (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: rr��11 <br /> Build new gabled dormer to front side of roof facing the street. Also finish off the Interior of the existing and new second floor space. U Zoning District <br /> This project is a new building or structure. L1 Permitted Use? <br /> 19 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER' ij Rural Address <br /> EWER DEPTIC 1 (new/existing) <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) <br /> 25.0 i 2.0 0 Wetland/Fioodplain/ <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: ��p v ❑ ErosionControl permit <br /> 196.0 r- '��/,0,3k_s ,` TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 1 00.0 3RD FLOOR: <br /> 1 L � filling/access) <br /> ' �� ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -� -' -' -0 -' -' $ 35,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ONo EDon'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 No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Wes 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) DYes '4No ❑Don't'Know <br /> 7. Is this to correct a violation? Dyes r4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► . <br /> 545-112(4/08) <br />