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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 /> Mike Winters ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3736 Fairview Drive Madison,WI 53704 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)334-2474 (608)772-5224 bwinters @columbus.k12.wi.us ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Mike Winters Self ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3736 Fairview Drive <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Madison,WI 53704 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 772-5224 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bwinters @columbus.k12.wi.us ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑PARCEL 014/0810-344-9790-5 R-2 DCPREZ-0000-01076 0.88 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Burke '/a: '/a'/4: ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> 3736 Fairview Drive Madison, WI 53704 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Pre-Fabricated Shed ❑ 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: ❑ Rural Address <br /> 17,11EVVER LEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 0.0 140.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 0.0 3RD FLOOR: 0.0 140.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ / and available options. <br /> (Please round to nearest dollar) "l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes JNo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes '4No <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) Ekes '4No ['Don't know <br /> 7. Is this to correct a violation? Elves INNo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -+ —• <br />