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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVID1 <br /> OWNER NAME _ <br /> Marianne Siess <br /> AZoning Status; CUP; �y <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM p jj <br /> 511 Powers Ave Madison,WI 53714 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-628-0968 marianne.siess @gmail.com 111 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions 2 DO <br /> AGENT NAME CONTRACTOR NAME <br /> Ralston Exteriors Ralston Exteriors Site Plan including locatio <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic- <br /> 7022 Maywood Ave 7022 Maywood Ave <br /> (City,State,Zip) (City,State,Zip) ra Setbacks 2-c-V/CAw 2 Y <br /> Middleton,WI 53562 Middleton,WI 53562 I <br /> PHONE PHONE Site Plan approval from /A/�jt <br /> 608-217-3373 608-217-3373 applicable township. 1� �T <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ryan @ralstonexteriors.com ryan @ralstonexteriors.com / Floor plans to scale / It <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL 008/0710-051-3165-0 frontage drawn to scale. <br /> NUMBER R-3 0.186 <br /> TOWNSHIP: SECTION: <br /> Town of Blooming Grove 5 %/ %IA:NE al P riveway per <br /> a:NW <br /> ADDRESS: (state,county, ) <br /> 511 Powers Ave <br /> IA CSM: LOT SUBDIVISION BLOCK/LOT S. - permits <br /> 12 GALLAGHER,ELISHA L 2N J ADD REPLAT OF BLKS (pub.;,private) <br /> 11,12,13,15,16&PT BLK 14 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Deck addition Z I` <br /> oning District . - 3 <br /> ❑This project is a new building or structure. 7 r gv <br /> 0 <br /> Permitted Use? 8 /l J <br /> This project is an addition/alteration to an existing building or structure. /�hi' <br /> SANITARY SERVICE: PERMIT NUMBER: KRuralA ,-LO- S/ `� <br /> EWER nEPTIC (n- ' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) AA <br /> 30",approx 60"with railing 1 tglNetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) /1 <br /> BASEMENT: 1ST FLOOR: 3 TCD 4, Eropes,disturbance,ntrol permit /O <br /> NAB TOTAL SQUARE FOOTAGE: + slopes,di J <br /> O filling/access) A <br /> 2ND FLOOR: 3RD FLOOR: 3 /� , <br /> NA NA ��/3 Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ –• ♦ –• –, ♦ 6,000.00 p ttons. <br /> Or <br /> and available o <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des gfr'lo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes �Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des Oslo <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) Des go Don't know <br /> 7. Is this to correct a violation? -- o <br /> APPLICATION MUST BE SIGNED <br /> 41 2 g �i-0 Continue on Back) —► ♦ —0 <br /> es»remai , .. <br />