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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 /> Michel Rezac & Kathy Debner E Zoning Status;CUP; <br /> OWNER ADDRESS(Number,Sweet,Cny,state,Zip) Deed Restriction;CSM <br /> 9 Piedmont Ct Madison Wi 53711 Variance(# ) <br /> HOME PHONE C _ • E-MAIL ADDRESS <br /> (608)239-9033 (608)335-0556 mrezac20 @yahoo.com Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME , k <br /> Kathy Debner Priority Buuilders [ ite Plan including location - S° "--"' <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic Y.'y"--- <br /> 9 Piedmont Ct 1088 Henry Rd <br /> (City,State,Zip) (City.Slue.Zip) ❑5setbacks I�-�"� <br /> Madison Wi 53711 Belleville Wi 53508 <br /> PHONE (608) 335-0556 PHONE (608) 235-0131 applicable township from <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mrezac20 @yahoo.com stevegemer@aol.com aPloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) CSL <br /> PARENT PARCEL NUMBER: CU ZONING: ACREAGE ©.Elevation of property �— l .- <br /> ❑PARCEL 0509-053-9860-1 ,pi— 49 2.40 frontage drawn to scale. I� <br /> TOWNSHIP: SECTION: N <br /> Oregon 5 %; se +/1/: sw tiveway permits — .....•2_,(.„.,5+, `h ` <br /> ADDRESS: <br /> 1385 Storytown Rd Oregon Wi (state,county,town) n pct <br /> CSM LOT SUBDIVISION BLOCK/LOT <br /> 9 Sanitary permits <br /> 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> Build new home lld Zoning District <br /> . 12 This project is a new building or structure. d Permitted Use? <br /> DThis project is an addition/alteration to an existing building or structure. �-�{/ <br /> SANITARY SERVICE: PERMIT NUMBER: 1.7 Rural Address <br /> EWER )EPTIC 13,201,700,005 (new/ xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) etland/Floodplain/ /-7 <br /> 21.0 1.0 plain/ S E� T <br /> AREA TO NEAREST SQUARE FOOT attachment) 00 4 <br /> (Outside dimensions including unfinished area.attached garages and above grade decks or porches) ErosionContr0l permit <br /> BASEMENT: 3,379.0 'STFLOOR:2,221.0 4 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: li a!`_3RD FLOOR ♦ <br /> filling/access) <br /> 5,600.0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available bons. <br /> (Please round to nearest dollar) -+ —°. $ 320,000.00 Op <br /> ti <br /> The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies 3o ['Don't know <br /> ❑ <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes [lo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal 4 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes ✓I Jo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Elo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —0. —► —► <br />