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w <br /> 1 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Dale & Kay Carmichael <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Tip) Deed Restriction; CSM <br /> 132 E.Wilson St.#1106 Madison, WI 537093 Variance(# ) <br /> HOME PHONE i CELL PHONE E-MAIL ADDRESS <br /> 608-576-0999 dale.carmichael @cahvacr.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Michael Frederick JM Frederick Custom Homes ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1283 County Road D Same <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Oregon,WI 53575 Same <br /> PHONE PHONE ❑Site Plan approval from <br /> 608-843-2789 Same applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> freddy.jmfcustomhomes @gmail.com Same ❑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 /> El PARCEL 018/0711-264-9915-0 R-1A 2.05 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> - Grove 26-7-11 1/4: SE 1/41/4: SE ❑Driveway permits <br /> ADDRE <br /> (state,county,town) <br /> 3474 Skar•tinden Road <br /> CSM. n LOT ■ SUBDIVISION BLOCK/LOT El(publtc ppvate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Home ❑ Zoning District <br /> 0 This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER rEPTIC 13-2018-00075 (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 2 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 1938 3IP% ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR:678 3RD FLOOR: filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q and available o tions. <br /> (Please round to nearest dollar) ♦ -• -• -• -• -• $ 500,000.00 p <br /> -1 tict8,613 - <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes Lilo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies ao Ion't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes ao <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ON <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 Do Eon't know <br /> 7. Is this to correct a violation? [Yes EINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -► <br /> 545-112(4l0e) <br />