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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 /> The Heffron Company <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) <br /> Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)643-8525 (608)963-6022 heff @Heffronhomes.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Daniel Heffron Jr. Heffron Homes ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2000 Prairie Street, Suite 220 2000 Prairie Street, Suite 220 <br /> (City,State,Zip) (City,State.Zip) ❑Setbacks <br /> Prairie du Sac,WI 53578 Prairie du Sac,WI 53578 <br /> PHONE PHONE <br /> El Site PI- r . oval from <br /> (608) 643-8525 (608) 643-8525 appli.,1, ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> heff @heffronhomes.com heff @heffronhomes.com ❑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 050/0907-184-4639-0 R-1 1.06 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Roxbury 18 1/4: SW 141/: SE ❑Drive a ermits <br /> ADDRESS: (state, ounty,town) <br /> 9353 Jenny Lind Lane, Sauk City, WI 53583 <br /> ` II Sanitary permits <br /> CSM: LOT 39 SUBDIVISION BLOCK/LOT <br /> (public;private)-'- y <br /> IC' CA Black Hawk Fields 39 (n <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New home construction/Two-story home with attached garage ❑ Zoning s ct <br /> . MI This project is a new building or structure. ❑ Permitte e? <br /> ❑This project is an addition/alteration to an existing building or structure 2 <br /> SANITARY SERVICE: PERMIT BE_ . 1 a�—� ❑ - al Address <br /> EWER [EPTIC 1�2_ 3 16 msp/existing) <br /> HEIGHT IN FEET: n „ NUMBER OF STORIES: (Not including basement) <br /> 22(6 1 ! 2 0 ❑ Wetland/Floodplain/ <br /> AREA T NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including nfinished area,attached garages d above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 1,073.0 2,591 .0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 1,136.0 r f 3RD FLOOR: 4 800.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -I. -1. -• ♦ ♦ -11. ', /- nd available options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des 1:2 No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ✓No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Y es ElNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des ✓❑No <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) Dies ❑No ['Don't know <br /> 7. Is this to correct a violation? :Yes t2 No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -o -► —► <br /> 545112(4108) <br />