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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C =T MER TO PROVIDE <br /> OWNER NAME <br /> Steven G and Jan M Gunderson <br /> a Wing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> 885 Jean Circle,Oregon,WI, 53575 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)835-8186 (608)446-6830 gun @mailbag.com Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> its Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> PHONE PHONE its PI approval from <br /> p• ble township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> loon plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONI • ACREAGE: Elevation of property <br /> [PARCEL 042/0509-153-4229-5 R1 DCPREZ-0000-01779 0.75 frontage drawn t tale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Oregon 15 1/4: SW 1/1/: SW Q Driveways <br /> ADDRESS: (state ounty,town) <br /> 885 Jean Circle, Oregon WI 53575 <br /> 0 Sanitary p- its <br /> CSM: LOT A n SUBDIVISION BLOCK/LOT <br /> '+7 Hillcrest Heights,2nd Addition (pu• is •rivate) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Replacement deck for former deck that has been removed. Replacement deck is smaller than the previous deck. ❑ r • ing Distiict <br /> ❑This project is a new building or structure. ❑ Permitted U <br /> isi This project is an addition/alteration to an existing building or struct re. <br /> SANITARY SERVICE: PERMIT NUMBER: /� ( ❑ Rural ress <br /> EWER EPTIC �J (new/ IStin <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not ind ding basement) <br /> 2.0 ❑ Wetland/F plain/ <br /> Shorelan (attach ) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCon!r permit <br /> 4 TOTAL SQUARE FOOTAGE: 4 (slopes, •*- rbance, ■ <br /> 2ND FLOOR: 3RD FLOOR: filling/- •=3S) <br /> 1740070 El Review Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -+ —' ♦ '" ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 7,500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes t/ Jo ['Don't know <br /> a.2. Is there a wetland or floodplain on or near the property? [Yes o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes OW <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 Q Jo [Don't know <br /> 7. Is this to correct a violation? [Yes Jio <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) Q 1 (Continue on Back)' S , 4 3 <br />