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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUS OMER TO PROVIDE <br /> OWNER NAME <br /> Kim Ponsegreau <br /> M 'oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D ed Restriction; CSM <br /> 3296 Saracen Way Verona,WI dance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)576-4266 to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Adam Hebgen Washa Construction, Inc. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4915 Farwell St 4915 Farwell St <br /> (City,State,Zip) (City,State.Zip) Setbacks <br /> McFarland,WI 53558 McFarland,WI 53558 <br /> PHONE PHONE ❑S. e Plan oval from <br /> (608) 838-8318 (608) 838-8318 plic a township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> ahebgen @washaconstruction.com ahebgen @washaconstruction.com oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of ro e <br /> ❑PARCEL PARCEL N�:ER: CUQ�2ENT ING' ACREAGE: P p <br /> 07 W. .,owe h. (y ,\ frontage drawn scale. <br /> NUMBER <br /> TOWNSHIP: ; 4 ,1 i\o SECTI c <br /> '/4: V %IA: ❑ Drivewa ermits <br /> ADDRESS: \ (stat ounty, • n) <br /> Q • �c�Ct' vV <br /> CSM: LOT ,UT(VISION BLOiKLOT El Sanita •ermits <br /> , C. ► '1 1 Q (p • private) <br /> PROPOSED PROJECT INFORMATION != 1 TAFF REVIEW <br /> PROJECT DESCRIPTION: Ci Detached Garage / P J ` •ning District <br /> . 151This project is a new building or structure. ` Permitted U <br /> This project is an addition/ Iteration to an existing building or stru ure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ pRural dykes <br /> FI <br /> EWER EPTIC (neW/ s,t,1 <br /> HEIGHT IN FEET: NUMBER OF STORIES: (N t including basement) ` <br /> 13.2 1.0 ❑ Wetland/F plaint <br /> Shor d (attach <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) `, , <br /> BASEMENT: 1ST FLOOR: ❑ ErgStOnCQn p8Fn1 ft <br /> 4, TOTAL SQUARE FOOTAGE: 4, (S Mies. urbance, <br /> 2ND FLOOR: 3RD FLOOR: 171 SS) <br /> 336.0 evtewLocation Survey 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ Q� and available options. <br /> (Please round to nearest dollar) $ 25,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ENO ❑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? [Yes ❑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) [Yes ENO ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —►C)C9 545112(4/O8) <br /> 4 f7 S e <br />