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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 /> Duncan Campbell ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4930 Felland Rd Madison,WI 53718 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)843-3939 DrCampbe1l56 @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ery Domask-Complete Construction ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5566 Galway Drive <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Waunakee WI 53597 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 577-8556 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Completeconstruction @TDS.net ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0810-351-9200-0 Al 5.70 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town fo Burke 1/4: 1/a'/4. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4930 Felland Rd Madison, WI 53718 <br /> CSM: 13 755 LOT 2 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> na na (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Accecory building/garage di-he gt-1 ❑ Zoning District <br /> . MI 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 NUMBER: ❑ Rural Address <br /> EWER EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 14.0 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> 0.0 576.0 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 0.0 0.0 576.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available O tions. <br /> (Please round to nearest dollar) ♦ -' "i -+ ♦ $ 20,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes '4No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes ONO <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ❑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 ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑✓No <br /> n <br /> VI •y 9-b 1 APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -1 —+ — <br /> \ 1 <br />