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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Ryan Brandon & Carle Champion <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status; CUP; <br /> 5038 Autumn Leaf Ln#302,Madison,WI 53703 Deed Restriction; CSM <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> (773)558-6116 cariechampion @yahoo.com <br /> O Site Plan drawn to scale <br /> AGENT INFORMATION <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sue Frohling Tim O'Brien Homes of Madison LLC <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4868 HIGH CROSSING BLVD 4868 HIGH CROSSING BLVD <br /> (City,State,Zip) (City,State,Zip) O Setbacks <br /> MADISON,WI 53704 MADISON,WI 53704 <br /> PHONE PHONE O Site Plan approval from <br /> (608) 661-1105 (608) 661-1105 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> sfrohling @tobhomes.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> OPARCEL 0910-294-4055-0 <br /> NUMBER R-2 0.34 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> TOWN OF WINDSOR(09) 29 1/4. NW 1/41/4. SE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> __, - Dusky Glen Cj (1,-,\ <br /> CSM: LOT SUBDIVISION BLOCK/LOT O Sanitary permits <br /> 277 WOLF HOLLOW (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> SINGLE FAMILY HOME <br /> 0 Zoning District <br /> O 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 /> 17/1EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 27.0 2.0 ❑.Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garage�,and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: �' ❑ ErosionControl permit <br /> 1,047.0 1 ,819.0 ,, TOTAL SQUARE FOOTAGE: ,, (slopes,°disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filiing/ s) <br /> 1 ,166.0 4,032.0 �.` <br /> Li ESTIMATED CONSTRUCTION COST: <br /> ` view n-Survey` <br /> end l b fip#IOnS(Please round to nearest dollar) -+ .- "+ -+ '♦ .- $ 224,500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes EINo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? JYes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes 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) E Yes ENo ODon't know <br /> 7. Is this to correct a violation? Elves ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aios) (Continue on Back) ■ ■ -+ <br />