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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> T-z. et?-01.9) <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Dale Baldwin (Baldwin Trust Dated May 21, 1993) <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status; CUP; <br /> 4350 Memorial Circle, Windsor, WI 53598 Deed Restriction;CSM <br /> HOME PHONE CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> (608)347-5779 (608)347-3563 sb1db@sbcglobal.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION !CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> self ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City.State,Zip) ❑Setbacks <br /> PHONE PHONE <br /> ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUR ENTZONING: ACREAGE: 0 Elevation of property <br /> 11 NUMBER 0910-294-2034-0 -K_a D,Yt A frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> • Windsor +/t. +/4,/+_ ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4350 Memorial Circle Windsor, WI 53598 <br /> CSM: LOT 4 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> Wolf Hollow (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Backyard deck- 12ft.x 22ft., approx. 2ft. above backyard elevation ❑ 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 SERVI : PERMIT NUMBER: ❑ Rural Address <br /> EWER PEPTIC TIC <br /> HEIGHT IN FE NUMBER OF STORIES: (Not inducing basement) ❑ WetlandlFl <br /> oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Er - nControl permit <br /> j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: d�, L <br /> �(1 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -► and available options. <br /> (Please round to nearest dollar) r��v " <br /> / <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓)Vo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes go ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓Yeso <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ✓❑Yes oNo <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) ❑Yes [lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [lo <br /> tI ��I ( J APPLICATION MUST BE SIGNED <br /> dig(,Q(9 v (Continue on Back) —► ♦ —► <br /> 545-112(4/68) ��411���"' <br />