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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU ` OMER TO PROVIDE <br /> OWNER NAME <br /> Brenda Jensema <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status; CUP; <br /> 6486 �eed Restriction; CSM <br /> 486 Nature Valley Dr <br /> ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)235-2442 edjensema @charter.net Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Blake Kelsey ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 238 E. Main St. Ste. B <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks �---- <br /> Marshall,WI 53559 <br /> PHONE PHONE ❑S. a Pla -appr vo al from <br /> (608) 212-8586 pli le township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> blake @greenlineconstruction.com loor 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 064/0909-363-2033-0 Residential 0.43 frontage drawn to.scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> &'\) Drivew ermit <br /> Town of Vienna 36 '/4: '/4'/4: NW(IOW ❑ <br /> ADDRESS: (stat ,count. , own) <br /> 6486 Nature Valley Dr, Waunakee WI 53597 <br /> CSM. LOT SUBDIVISION BLOCK/LOT El S"nit-' permits <br /> NATURE VALLEY CONSERVATION NEIGHS/3 1 5 (��U�, c, private) <br /> 4 <br /> PROPOSED PROJECT INFORMATION •TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Deck al P .ping District <br /> . IMIThis project is a new building or structure. ❑ Permitted Us ? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER. J� l ❑ Rural ddress <br /> EWER [-SEPTIC / v (new/e fisting <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not in( asement ding ) <br /> 9.0 1.0 Li Wetland/FI dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shorelapd (attar ent) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCo rol permit <br /> 4 TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> fillinpccess) / <br /> 2ND FLOOR. 3RD FLOOR: <br /> .192.0 . <br /> ❑ Review Lo ion Survey <br /> ESTIMATED CONSTRUCTION COST: -+ - ♦ -► —' ♦ and av .able options. <br /> (Please round to nearest dollar) $ 8,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes is ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? FIYes FIND ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Wes FIND <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ONo <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 ODon't know <br /> 7. Is this to correct a violation? I—Yes 4No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) Q0 (Continue on Back) <br />