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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME C Cu•TOMER TO PROVIDE <br /> 4<fr barLY- ,udenz.-k�leri14- `i '-; vl .J, t,OWNER ADDRESS (Number,Street,City,State,Zip) y Zoning Status;CUP; <br /> G z f l ..$441 Sun Valley Parkway Belleville,WIt 53508�gQ Deed Restriction;CSM <br /> HOME PHONE CELL PHON6JL3 C,yE-MAIL ADDRESS ariance(# ) <br /> (608 <br /> AGENT INFORMATION Si Plan drawn to scale <br /> CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME t f ,. CONT NAME...`["�, e JM rederic Custom Homes&Properties, LLC <br /> AGENT ADDRESS Si Plan including location <br /> CON OR ADDRESS well/septic <br /> 1283 County Road D <br /> (City,State,Zip) <br /> (City,State,Zip) Setba ks <br /> Oregon,WI 53575 <br /> PHONE PHONE <br /> (608) 843-2789 ❑Sit <br /> I. lane township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> freddy.jmfcustomhomes @gmail.com or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> 0 PARENT PARCEL NUMBER: CURRN7 Q�,Iljj NING:( ACR •GE: -vati0 • <br /> PARCEL 0508/121/8720/0 -� <br /> NU MBER <br /> ge • • scal- <br /> TOWNSHIP: SECTION: / <br /> Montro e 12 /a: %�a: T5N,R8E r' eway permits G <br /> ,, te:9 <br /> ADDRESS: /" / ;; — ( ate,coon •Wn)CSM: (��/ LOT Vv '. �� <br /> 14,081 2 SUBDIVIS i-ckrie. BLOCK/LOT . Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: .y TAFF:REVIEW <br /> New Home Construction i '\� a 'EC it Q O Z+ming District•This project is a new building or structure. . ' <br /> ❑This project is an addition/alteration to an existing building or structure. �' ants ed Use? <br /> SANITARY SERVICE: PERMIT NUMBER: n RU - Address <br /> EWER IEPTIC 13,201,500,290 (n existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 29.5 2.0 ® Wetland/F plaits. <br /> AREA TO NEAREST SQUARE FOOT: Shorel jattachme ) <br /> (Outside dimensions including unfinished area attached gara s and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionCon, • •ermit <br /> 1,436.0 .7 • 4, TOTAL SQUARE FOOTAGE: j (slopes,di 0 rbance, <br /> 2ND FLOOR: 1,284.0 3RD FLOOR: ' filling/ sS) \ <br /> S.V7 , <br /> ESTIMATED CONSTRUCTION COST: ❑ Rev' W Location Survey <br /> (Please round to nearest dollar) i -+ -± ♦ ♦ $ 350,000.00 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ✓ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? <br /> es ONo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓ es o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes FNo <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) QYes ONo ODon't know <br /> 7. Is this to correct a violation? <br /> Efres O✓No <br /> 4 APPLICATION MUST BE SIGNED <br /> 545-112 iaioa> �� (Continue on Back) —► ■ —+ <br />