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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 /> Thomas R. and Martha J. Glowacki ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7340 Loper Road Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)643-3099 235-3630 tomglowacki36 @gmail.com Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Thomas R.Glowacki Bill Muir <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7340 Loper Road 7413 Cedar Stone Drive <br /> (City,State,Zip) (City,State.Zip) ❑Setbacks <br /> Sauk City,WI 53583 Sauk City,WI 53583 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 643-3099 (608) 219-1211 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tomglowacki36 @gmail.com muircc @gmail.com IO Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0907-142-9820-7 RH-2 5.75 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Roxbury 14 1/: SE %%: NW ❑ Driveway permits <br /> ADDRESS (state,county,town) <br /> 7340 Loper Road, Sauk City, WI 53583 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> addition to basement studio ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> 14 This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address' <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 15.0 1.0 ❑ Wetland/Floodplain <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 1-1 <br /> ErosionControl permit <br /> 352.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 352.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ .- ♦ -+ $ 66,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑✓Yes ENO ❑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'? [Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years . q ❑Yes rdNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# Si 0 ( ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes NINo ['Don't know <br /> 7. Is this to correct a violation? Oyes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► <br /> 545-112(4/08) <br />