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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 /> Ryan Bendixen ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4382 Juliana Lane DeForest,WI.53532 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)842-0592 (608)206-5818 ryanbendixen @hotmail.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Capitol Pools,LLC ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2890 Terra Court,Suite 12 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Sun Prairie,WI.53590 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 837-7665 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mail @capitolpool.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0910-203-0912-0 R-3 DCPREZ-0000-08893 0.20 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Windsor-TO9NR10E 20 1A. NE +/1 • SW El Driveway permits <br /> /a a. <br /> ADDRESS: (state, county,town) <br /> 4382 Juliana Lane Deforest, WI. 53532 <br /> CSM: LOT 182 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> First Addition to Holland Fields (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Pool Installation ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> WER FIEPTIC (new/existing) <br /> HEIGHT IN FEE : NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <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: 1 ST FLOOR: ❑ <br /> ErosionControl permit <br /> 1 TOTAL SQUARE FOOTAGE: ,, (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 455.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ rD �/ and available options. <br /> (Please round to nearest dollar) j <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres lalo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Ilo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? res Olo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes alo <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) Ekes :No ❑Don't know <br /> 7. Is this to correct a violation? Dies ao <br /> /2 APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/08) <br />