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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU*'TOMER TO PROVIDE <br /> OWNER NAME <br /> Ron Klaas Shelley Swenson Q zortipg Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) ' peed Restriction;CSM <br /> 798 Alpine Pkwy,Oregon WI 53575 1� <br /> ariance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (608)225-1550 sswenson @cuna.coop <br /> '' <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION 40jaeludesadinlemsisar: ''' <br /> AGENT NAME CONTRACTOR NAME <br /> riI1E1lltfiJeanette Acker Premier Builders Inc. <br /> "I� t <br /> AGENT ADDRESS CONTRACTOR ADDRESS •f well/se.tic ilt <br /> 102 N Holiday Drive 102 N Holiday Drive <br /> (City.State.Zip) (City.State.Zip) ` Setbacks <br /> Waunakee W 53597 Waunakee WI 53597 <br /> PHONE PHONE ❑Pite Plan approval from <br /> (608) 576-7240 (608) 849-6770 %applicaJe'township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS 5 <br /> jeanette.acker @gmail.com jeanette.adcer@gmail.com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRANT Z NING: ACREAGE: i-- <br /> 0 PARCEL 0509-072-9685-0 y �� r`\' frontage drawn to scale. <br /> NUMBER `T' <br /> H `,.) - <br /> TOWNSHIP: SECTION: yy <br /> • Oregon 7 '/4: .. (U '/4'/. �nw. ❑l'veway,permlts <br /> ADDRESS <br /> (State,county,town) <br /> CSM LOT SUBDMSION BLOCK/LOT Sanitary permits <br /> 13,273 2 (public,private) <br /> PROPOSED PROJECT INFORMATION 1 STAFF.REVIEW <br /> PROJECT DESCRIPTION: � � ^ ` �," [�iZonin District <br /> New Home Construction fJ ( C C' '\:e\' t ` C ; Cj g. <br /> . 4 This project is a new building or structure. ❑`I ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER:. Q ❑tr)3ai Address <br /> FIEWER 1EPTIC / ^S C C) CC��,. 1 xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) :,-, <br /> C U 2.0 ❑ Wetland/Floodplain/ <br /> Shorela d'fattachment) <br /> AREA TO NEAREST SQUARE FOOT: - i <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ❑ Eros)ibnControlpefimit 7 <br /> 2,946.0 \; 4,939.0 \, 4 TOTAL SQUARE FOOTAGE: 4, (slgte$s,�dist$urbance, <br /> 2ND FLOOR: / 3RD FLOOR: fi�Iing/' ) <br /> 4 <br /> 1,324.0 �, 9,209.0 /( <br /> a Review Location Survey <br /> ESTIMATED CONSTRUCTION COST and available o tions. <br /> (Please round to nearest dollar) -* ♦ ♦ ♦ -* - $ 890,000.00 p <br /> 1. 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? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓❑Yes Dslo <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) :Isles ❑No al Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> f t APPLICATION MUST BE SIGNED <br /> , (Continue on Back) ♦ -► •-• <br /> $45112(4A8) 1 L� ! ( <br />