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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Gregory and Bette Granberg <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Ressttrictirus Status; CUP; <br /> i <br /> 4419 Goodland Park Rd, Madison, WI 53711 Variance on;CSM <br /> Vnce(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-514-1717 608-575-0329 betteandgreg @gmail.com elan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Greg Granberg a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4419 Goodland Park Rd <br /> (City,State,Zip) (City,State,Zip) • etbacks <br /> Madison, WI 5371 <br /> PHONE PHONE ite Plan approval fro <br /> 608-575-0329 applicable township. " <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> greg.granberg @gmail.com oar plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: R.Eigration of property <br /> [PARCEL 028/0610-082-6313-9 R-3 0.201 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTIO ' <br /> Dunn 1/4: /U W 1/41/4: -SE Elptway permits <br /> ADDRESS: (state,county,town <br /> 4419 Goodland Park Rd <br /> CSM: LOT SUBDIVISION BLOCK/LOT nary permits it/A_ <br /> (public;private) <br /> o IA XN • -.r '3 <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ' I ill. <br /> Repair Foundation Wall . <br /> . <br /> This project is a new building or structure. <br /> El This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: -' <br /> EWER [EPTIC : <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ft.\ <br /> (r7 tom• <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> 90 1 TOTAL SQUARE FOOTAGE: <br /> 2ND FLOOR: 3RD FLOOR: 90 <br /> ESTIMATED <br /> lease r ED CONSTRUCTION COST $ $4,500 <br /> Please round to nearest dollar) ♦ ♦ "♦ ♦ ♦ ♦ J <br /> 1. The property is within 300 feet of a stream o107)0 feet from a pond or lake Sfes No Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes IDNo [Don'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 ©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 ENo [Don't know <br /> 7. Is this to correct a violation? [Yes ©No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ —► <br /> 545-112(4/08) <br />