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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 /> Thomas S and Doreen D Schuchardt Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3132 Waucheeta Trail,Madison,WI 53711 <br /> Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)222-6867 (608)445-1683 thomss @me.com028/06101 []Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) :Setbacks <br /> PHONE PHONE 0 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> El Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONI ACREAGE: <br /> WA NUMBER RC 028/061017285200 -Z Lb 13.06 frontage drawn to scale. <br /> TOWNSHIP: SECTION: 11 <br /> Dunn 8 1/4: i/4�/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 4424 Stace Road <br /> CSM: 13 423 LOT 1 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> patio and raised planters ❑ Zoning District <br /> ❑This project is a new building or structure. <br /> ❑ Permitted Use? <br /> O This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> tb a ❑ Wetland/F000dplain! <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: ��p�p� 1ST FLOOR: <br /> �ybC1 V ,l TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ $ 1 ,000.00 <br /> 4tt,( . -(s <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes J io :Don't know <br /> 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? res o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes E-1Vo <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 ❑Don't know <br /> 7. Is this to correct a violation? :Ye s o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —1 —0 —0 <br /> 545-112(458) <br />