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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 /> Scott J. & Cheryl A. Wilson ,e-4 <br /> 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2861 Henshue Rd. Madison, WI 53711 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)575-7790 (608)575-7790 scwilson @wilsonwoodcraft.com <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Same As Owner Wilson Woodcraft Inc. f4 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2861 Henshue Rd. <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> Madison,WI,53711 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 575-7790 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> scwilson @wilsonwoodcraft.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0610-071-8225-0 R-1A 1.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunn 7 /4: NW /,1/4. NE 0 Driveway permits <br /> ADDRESS: (state, county,town) <br /> 2824 Dorothy Dr. Madison, WI 53711 p sanity <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 11,916 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIE <br /> PROJECT DESCRIPTION: —/ <br /> New SFR for Scott J. and Cheryl A.Wilson R &Zoning District <br /> III This project is a new building or structure. Permitted Use? /6 <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ik.Rural Ad• ° <br /> FIEWER [EPTIC (new ° <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 25.0 1.0 iIfWe1landf .odplain/ <br /> AREA TO NEAREST SQUARE FOOT: o _ ° <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches <br /> TOTAL SQUARE FOOTAG-• ® (slopes,disturbance, <br /> it <br /> BASEMENT 1ST ST FLOOR: 5,708.0 4 thin• access).: . <br /> 2ND FLOOR: 3RD FLOOR: 9,403.0 <br /> ESTIMATED CONSTRUCTION COST: Review Location Survey <br /> (Please round to nearest dollar) ♦ -' —. ♦ ♦ ♦ $ 350,000.00 and avaHable options. h tot- <br /> 3 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Des 171No ❑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? ❑Yes ONo <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? EYes IN No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />