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V4(1 17? r <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Hawkin Zukowski <br /> El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4898 Felland Rd Madison,WI 53718 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)770-0247 Zukowskih @uwstout.edu ❑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.usn I=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: <br /> ❑PARCEL 0810-351-9400-0 Al 1.95 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION. <br /> Town fo Burke '/4. 1/4%. ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4898 Felland Rd Madison, WI 53718 <br /> CSM: 13 755 LOT 4 SUBDIVISION BLOCK/LOT ❑Sanitary perm s -- �� <br /> na na <br /> (public,private/W` <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Accecory building/garage ❑ Zoning Dis ' <br /> . 0 This project is a new building or structure. ❑ Permitted V/" <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/e' i <br /> HEIGHT IN F ET: ) 16.0 r, a� NUMBER OF STORIES: (Not including basement) <br /> [Fy✓)�" 1.0 ❑ wetland/Floodplain! <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> 0.0 1 ,728.0 <br /> + TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 1 ,728.0 <br /> O ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -* '♦ ♦ -► -* $ 30,000.00 <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 FANo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? res ❑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# ) (le ve blank if none) <br /> 6. Is a location survey required? (see reverse) Yes INo ❑Don't know <br /> 7. Is this to correct a violation? [Yes ✓❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ -+ <br /> 545-112(4/08) <br />