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. . <br /> ZONING PERMIT APPLICATION www.countyofdane.com 0121:1131=7 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME DANE & CHRISTINE HENDRICKS i.i <br /> rZoning Status; CU'• <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction 40 , <br /> 5002 AUTUMN LEAF LANE #316,MADISON,WI 53704 5 ia�/ <br /> Variance(# ) o <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 4 <br /> (608)225-8430 CHRIS_1900 @HOTMAIL.COM ,� Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CONCEPT BUILDERS OF MADISON,LLC CONCEPT BUILDERS OF MADISON,LLC 14 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 804 WI ,Zip) WAY G 3�3 0/40/0 <br /> (City,State,Zip) (City,State,Zip) 4Setbacks <br /> WAUNAKEE,WI 53597 <br /> PHONE PHONE Site Plan approval from <br /> (608) 234-4752 pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> rob @myconceptbuilders.com VFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p P y <br /> ❑PARCEL 058/0811-324-8200-2 R-1 0.97 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> SUN PRAIRIE(08) 32 1/4: SE 1/41/4. NE Driveway permi <br /> ADDRESS: (state,county,: <br /> LOT 4 - ALVIN ROAD �3 2- A /v',' ►-. <br /> Sanita oe... . <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 4,508 4 (publi., private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW /( k <br /> PROJECT DESCRIPTION: «� /� <br /> SINGLE FAMILY RESIDENCE Zoning District 3 ` <br /> / <br /> . Igi This project is a new building or structure. Permitted Use? s F <br /> fThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: R Address <br /> EWER [EPTIC 520,325 0/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 25.0 1.0 X Wetland/F000dplain/ <br /> AllA4 <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionCOntroi permit M <br /> 2,293.0 4,175.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, //��" <br /> filling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 <br /> 4,175.0 <br /> Reuiew Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. 'U <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -i ♦ $ 340,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes EINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Lilies alo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [lies ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? OYes 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 QNo Don't know <br /> 7. Is this to correct a violation? Efres BINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -1 <br /> 545-112(4.08) <br />