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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 /> Madison College ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1701 Wright Street,Madison,WI 53704 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tony Sullivan-Findorff J.H.Findorff&Son ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 300 S.Bedford St. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Madison,WI 53703 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 441-6882 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tsullivan@findorff.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT Z NING: ACREAGE: <br /> ❑PARCEL 2 B /a �Lf O�g6C}' u, 0�' ©^ frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • City of Madison '/a: '/s'/a: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1701 Wright Street <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted`Use? <br /> 151This 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 /> 190.0 3.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionContro(permit <br /> 4, TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ and available options. <br /> (Please round to nearest dollar) -. -. -0. <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 •lo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes Elo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes IDNo <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 Jo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Jlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> 545-112 14/08) <br />