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- -N 1 C-4 <br /> -. ZONING PERMIT APPLICATION ww .countyofdane.com SUPPLEMENT to Web-App # <br /> w <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> William R. McNary <br /> OWNER ADDRESS (Number,Street,City,State,Zip) [t,j.Deed Status;CUP; <br /> Deed Restriction;CSM <br /> 4810 Windsor Prairie Road Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 846-8772 mac6©centurytel.net Ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> r_pirePlan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE L -Sitel5 an approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> El..FiISor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) �gyation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL 090936403164 RH_1 1.85 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Vienna 36 '/a: SE %1/a: NE rive pe <br /> ADDRESS: <br /> (state, ty,town) <br /> 4810 Windsor Prairie Road <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 26 ani Its <br /> Windsor Prairie (publi rivate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Cloning District <br /> . 0 This project is a new building or structure. Lijfiirmitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural A...- <br /> 1)EWER [EPTIC (new/. 3.n <br /> HEIGHT IN FEET: 21 0 NUMBER OF STORIES: (Not 1.0 induding basement) Wetlend/FlOOdplai& <br /> I Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Lrosioncontrol pe f <br /> BASEMENT: 1ST FLOOR: 1 <br /> 1,680.0 j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) 9 <br /> 2ND FLOOR: 3RD FLOOR: "I ' <br /> 1,680.0 <br /> Revi 1on Survey <br /> ESTIMATED CONSTRUCTION COST: ► ♦ --6' -+ ♦ ♦ $ 12 000.00 and available options. <br /> - <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? [Wes ✓[ o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? 01'es �o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [JYes 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 1:::yslo ✓QDon't know <br /> 7. Is this to correct a violation? [JYes ✓}Io <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -► <br /> 545-112(4)58) <br />