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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 /> Ryan Chandler <br /> © Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4601 Plantation Court Middleton,WI 53562 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)836-4062 (608)516-7123 ryan.chandler @amerhart.com t[ 'Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> — A)0 A)£ — —5i4 fi7 C. /15 i.,g. - QSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑NUMBER 038/0708-043-2122-0 _/ 0.,q 8;. frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Town of Middleton ,4: wy4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> - ;49/ hj-},tJ77*770A) r;t, ////ppt-e 77 ,rJ, C u/ ...,.r..�'1s <br /> CSM: LOT SUBDIVISION BLOCK/LOT El Sanitary permits <br /> y0 LOP/s, ER i per 0 (public, private) <br /> Cta r <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Deck renovation and expansion ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> Li Permitted Use? <br /> al This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 6.5 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ <br /> ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> X87 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 3,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓NO ❑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? [Iles ❑✓No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) [Yes ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes NI No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ♦ -+ —O. <br />