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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 /> Jim Mechler ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1125 Dunkirk Ave Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)444-7089 (920)605-0053 jim @jmecinc.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dream Kitchens El Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 5117 Verona Rd <br /> (City,State.Zip) (City.State,Zip) ❑Setbacks <br /> Madison,WI.53711 <br /> PHONE PHONE El approval <br /> (608) 204-7575 applicable Site Plan township.from <br /> E-MAIL ADDRESS <br /> E-MAIL <br /> kbear @drmkit.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accersosNcliNaGne.co.dane.wi.us/) <br /> ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑PARCEL • 3;� D9 3 Q 0 3 d Z ( - frontage drawn to scale. <br /> NUMBER �C `` <br /> TOWNSHIP: SECTION: <br /> Stoughton 1' '/4: '/a'/a: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1125 Dunkirk Ave <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> ° g :; t <br /> Repair to exisitng section of house 7,,41 - <br /> ❑This project is a new building or structure. 2 *( <br /> `this project is an addition/alteration to an existing building or structure. r <br /> SANITARY SERVICE: �y PERMIT NUMBER: <br /> EWER I�(3EPTIC a ' <br /> HEIGHT IN FEET: "+ NUMBER OF STORIES: (Not including basement) ^;,.. „ �� ; <br /> ` ^7 % <br /> Cam- g ,: ' e rs':,.„ s ''' } <br /> Try ¢ 6. a ,Ir sl sue; <br /> AREA TO NEAREST SQUARE FOOT: ^_ ,.. ' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ., <br /> x .. a ,fs� t' <br /> BASEMENT: 1ST FLOOR: _ <br /> j TOTAL SQUARE FOOTAGE: + a �r, , �� <br /> ���, . tea . � �' <br /> 2ND FLOOR: 3RD FLOOR: ` : ', 7 ' ' <br /> ESTIMATED CONSTRUCTION COST: Zr” Q � m <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ s; <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? <br /> Efres alo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No ©Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®1'es ac) <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Wes ❑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 �lo ®Don't know <br /> 7. Is this to correct a violation? Yes �lo <br /> APPLICATION MUST BE SIGNED <br /> �ti (Continue on Back) ♦ -. —► <br /> 545-112(4.08) <br />