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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 /> John and Sally Bertelson Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1039 Drumlin Drive,Oregon,WI 53575 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)712-4835 ['Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ed Hefty Construction,LLC Ed Hefty Construction,LLC ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1036 Hillcrest Lane 1036 Hillcrest Lane <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> Oregon,Wi 53575 Oregon WI <br /> PHONE PHONE ['Site Plan approval from <br /> (608) 835-7804 (608) 835-7804 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> vacationed @aol.com vacationed @aol.com ['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 /> D PARCEL (� // �- <br /> frontage drawn to scale. <br /> TOWNSHIPER ©��Q�/�� ^� ~ O (\\SECTION: <br /> Dunn /6 '/4: 5'' '/.'/e: S'5 ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> Keenan Road, McFarland, WI Z y35---" <br /> CSM: 12,242 2,242 LOT 2 SUBDIVISION BLOCK/LOT permits <br /> 2 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New single family home ❑ Zoning District <br /> . 51 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: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER [EPTIC 520,386 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 24.0 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) 1—, EroSionCOntrol permit <br /> BASEMENT: 3,357.0 1ST FLOOR: 3,582.0 1 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> ♦ filling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 <br /> 3,582.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -' • -' -♦ • • $ 426,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓ Jo []Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes 10INo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYeslo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes Jo <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) Q✓Yes OW ODon't know <br /> 7. Is this to correct a violation? ['Yes laio <br /> , .)fig G APPLICATION MUST BE SIGNED <br /> I (Continue on Back) -► <br /> sass laros> , ..9.------1,, 0 o `l iO <br /> iko., $ <br />