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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 /> Patrick and Shawna Richgels <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status;CUP; <br /> 8689 Airport Rd,Middleton,WI Deed Restriction;CSM <br /> HOME PHONE CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> (608)836-0418 (608)219-9743 pat @richgels.com [Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> SAntE- S o t,., Kt R- S&B Construction of Sauk Prarie [Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 614 Snyder Dr <br /> (City,State,Zip) (City,State,Zip) <br /> Setbacks <br /> Dane,WI 53529 <br /> PHONE PHONE <br /> Site Plan approval from <br /> (608) 225-9217 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ssmeier @tds.net [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 /> [PARCEL 038/0708-064-8100-7 A-1 5.02 frontage drawn to scale. <br /> NUMBER g <br /> TOWNSHIP: SECTION: <br /> MIDDLETON 6 14; SE +%1/4, NE 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 8689 Airport Rd <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 4,641 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> bedroom addition ❑ Zoning District <br /> OThis project is a new building or structure. <br /> L3 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER IEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 17.0 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: ❑ ErosionControl permit <br /> 1,200.0 1,200.0 4, TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 1 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q and available options. <br /> (Please round to nearest dollar) -0 -0 -° -° -° -0 $ 95,000,00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Elo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes 1/ o [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ✓ to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 7lo <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 OVo ❑Don't know <br /> 7. Is this to correct a violation? [Yes Ilo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(8109) <br /> (Continue on Back) -0 -i -► <br />