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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Diane Dzikowski ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) Deed Restriction; CSM <br /> 4016 Alvarez Ave Madison,WI 53714 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)239-3898 holykowkirby @yahoo.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> NA Brett Dollar ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3111 Siggelkow Rd <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> McFarland,WI 53558 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 516-9104 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> brettdollarconstruction @yahoo.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 008/0710-041-4254-2 R-3 0.21 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: ❑Driveway permits Grove 4 SW 1/41/4: NE <br /> ADDRESS: (state,county,town) <br /> 4016 Alvarez Ave <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 4,917 2 CLYDE A GALLAGHER GARDEN 4/2 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> detached Garage/workshop ❑ Zoning District <br /> . 0 This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuralAddress <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: 1 5.0 n ❑NUMBER OF STORIES: (Not induding basement) Wetland/Floodplaln/ <br /> AREA TO NEAREST SQUARE FOOT: ShOrelend (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> T 1 ST FLOOR: O ❑ ErOSiOl eo l permit <br /> BASEMENT: <br /> 032.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,dirbance, <br /> fillingfaccess) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 0.0 0.0 832.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and avalialle Options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ .- $ 30,000.00 <br /> it i12-Ll° <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres NI No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 12 No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Elves ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 12 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) [Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? [Yes filNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -► <br /> 545-112(4/08) <br />