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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 /> Jeffrey & Autumn Knudtson ❑Zoning Status P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed s tion; CSM <br /> 5712 Tonyawatha Trail Monona WI 53716 Varianc # ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)575-1410 (608)575-1410 jknudtson @nickleselectric.com ❑Site Plan draw to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includelimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Same Same ❑Site Pjaryihcluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel eptic <br /> (City,State,Zip) (City,State,Zip) ❑Seipeajs <br /> PHONE PHONE ❑Site Pl t�it• :I from <br /> applic ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ['Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usi) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevatio Of operty <br /> 12 PARCEL 0712-211-8115-0 RH1 2.32 frontage r wn to scale. <br /> NUMBER , <br /> TOWNSHIP: SECTION: <br /> g(bA Deerfield 21 1/4: NE 1/,,1/4: NE ❑Drivewa per is <br /> ADD Ess: (state, co y,town) <br /> Zander Lane <br /> CSM: 13,382 LOT 1 SUBDIVISION BLOCK/LOT ❑(public, pe Its <br /> (public, ate) 4 (,1,c <br /> PROPOSED PROJECT INFORMATION:, � - <br /> PROJECT DESCRIPTION ' <br /> New single family residential home �, 4: <br /> . rd This project is a new building or structure. •-•:1 ,', <br /> �. . <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE. PERMIT NUMBER: -. <) <br /> rEWER [EPTIC 13,201,500,073 0 1t ttv . -- <br /> HEIGHT IN FEET: i) MBER OF STORIES: (Not including basement) <br /> 19i { . <br /> ;° , 1.0 � s 4 ire <br /> F t �3 <br /> AREA TO NE ST SQUARE FOOT: �� a <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: $ a€ � § <br /> 2,060.0 3,027.0 y TOTAL SQUARE FOOTAGE: 4 e, . . i <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0.0 0.0 5,087.0 ' : <br /> ?��;Fg�t,e tag - ._- <br /> ESTIMATED CONSTRUCTION COST: n , ■g ! $ <br /> (Please round to nearest dollar) ♦ ♦ .- ♦ ♦ ♦ $ 260,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ❑✓No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ONo ❑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 yearsa).E. Elves No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# I U 1' ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Lives QNo ❑Don't know <br /> 7. Is this to correct a violation? [Yes NI No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />