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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU:TOMER TO PROVIDE <br /> OWNER NAME <br /> Kimberly Budenz Klein <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ' Zo g Status; CUP; <br /> 6441 Sun Valley Parkway Belleville,WI 53508 D d Restriction; CSM <br /> riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)206-5653 Kim Klein<kklein @bunburyrealtors.com> S" a Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION 76 includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JM Frederick Custom Homes&Properties,LLC ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 1283 County Road D <br /> (City,State,Zip) (City,State Zip) Setbacks <br /> Oregon,WI 53575 <br /> PHONE PHONE ❑ Ite Plan a oval from <br /> (608) 843-2789 plica township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> freddy.jmfcustomhomes @gmail.com loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRE TZO.IN : ACREAGE: p p rty <br /> ❑ <br /> NUMBER 0508/121/82918-�— R P r � p2 frontage drawn to scale. <br /> TOWNSHIP: • To w SECTION <br /> Montrose 12 '/a: E %IA: -T- R8E'-• ❑ Iveway permits k--- <br /> ADDRESS: C�J_ 2 `� \( (state, county,town) i/0 <br /> l l v o " I lel i �� Sanitary permits CSM: LOT SUBDIVISION OCK/LOT <br /> 14,081 1 <br /> (,ublic, private) <br /> PROPOSED PROJECT INFORMATION ; AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Home Construction IN\ t giN(3y\ t- cee( O C C.- S • + ing District <br /> • Ig This project is a new building or structure. • Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or sttrrt tore. <br /> SANITARY SERVICE: ,' <br /> NUMBER: )3--.. 01� �� ^00 FA ,' ' ddresS <br /> EWER 1EPTIC -1 "1 d� &- (new/'xisttng) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 29.5 2.0 0 Wetland/Fl plain/ <br /> AREA TO NEAREST SQUARE FOOT ShOfel (attachment) <br /> (Outside •'--- '..•- '• ding unfinished areaLitt,a4Pectgaca es and above grade decks or porches) <br /> BASEME T. 1 ST F R: ❑ ErosionControl permit(� 9 <br /> 1,774.0 2,948.0 + TOTAL SQUARE FOOTAGE: , (slopes,disturbance, c1 Ay <br /> 2ND FLO! 3RD FL ng/access) ` C� <br /> 826.0 5,548.0 Review Location Survey (16sS <br /> ESTIMATE• STRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ "i $ 350,000.00 .l_ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes rNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes JNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑✓Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Y ONo <br /> 5. Is this project associated with a rezone/CUP/varia ce(petition/appeal# ) (le a blank if none) <br /> 6. Is a location survey required? (see reverse) es 1ENo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes is No <br /> I APPLICATION MUST BE SIGNED <br /> 545-112(4/08) 2 ` 1 r 1° (Continue on Back) ♦ ♦ -► <br /> . CP <br />