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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 /> Heidi Kirkpatrick ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1218 Birdie St. Edgerton,WI 53534 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)284-0972 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Scott Meier Ed Scott Builders LLC ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> same as contractor PO Box 78 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Oregon,WI 53575 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 835-8488 applicable township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> edscottbuilders @gmail.com ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 002/0512-054-5530-0 R-1 1.17 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Albion 5 1/4: SW 1/41/4: SE ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 1218 Birdie St. <br /> CSM: 11,350 LOT SUBDIVISION BLOCK/LOT <br /> 11 1 ❑Sanitary permits <br /> Blue Meadow Estates formerly lots 3&4 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Addition to House ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> rThis 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 /> 24.0 1.0 ❑ Wetland/Ftoodplain/ <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: / ❑ ErosionControl permit <br /> 182.0 182.0 j TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: / filling/access) <br /> 364.0 p Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 60,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ONo siDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ❑No. LDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes J�--�LIl�VO <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes `Jo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# &7385 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ONo EDon't know <br /> 7. Is this to correct a violation? ❑Yes . IgNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —■ <br /> 545-112(4/08) <br />