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'SOA 0O c2--- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO ROVIDE <br /> OWNER NAME c <br /> OWNER ADDRE Sandra,NumberStreet, <br /> ty,TShomass Rutherford <br /> ❑Zoning s;CUP; pp/ <br /> Deed Re triction;CSM <br /> 1824 V i las Ave,Madison,WI,53711 <br /> Variance(#__ _____) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-3473908 rutherford.san®gmail.com ❑Site Plan aw scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Joel Nelson ❑Site Pla I uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s is <br /> 125 S.Thompson Road <br /> (City,State,Zip) (City,State,Zip) ❑Set6ks <br /> Sun Prairie,WI 53590 <br /> PHONE PHONE ❑Site Pkrrapproval from <br /> 608-6092214 applicFabie fuVishi p. <br /> E-MAILADDRESS E-MAILADDRESS <br /> joelnelson@jnwoodworks.com ❑Floor pla S scale <br /> PROPERTY/LOCATION INFORMATION (http:/Iaccessdane.co.dane.wLus/)NUMBER: ❑Elevati of operty <br /> PARENT PARCEL CURRENT ZONING: ACREAGE: <br /> ❑PARCEL ell, 032-8580-0 RR4 Rural Residential 4 frontage awn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Roxbury 3 �� NW i/q:__Y Nw _ El Drive ay rmits <br /> (state, unty,town) <br /> ADDRESS: <br /> .6 f next -8 t3 Schoepp Rd 4n El Sanitary permits 4 4O 1 <br /> M LOT SUBDIVISION BLOCK/LOT �i <br /> 14772 4 (public,pl e) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> A single family residence ❑ ZoningIrict <br /> . El This project is a new building or structure. ❑ Permitte se? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ I Address <br /> EWER ITIFEPTIC No. 13-2020-00446 new xisting) <br /> HEIGHT IN FEET: r NUMBER OF STORIES: (Not inducing basement) E '0,�n <br /> t�1'_ecu1 '� LI Wetl <br /> �At grade 1.5 oapI <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) e0 hl. 2.0"7-0 OD 1°84❑ ErosionControl permit <br /> BASEMENT: 1 521 1ST FLOOR: 1_82-..-1.7„)(�4 4. TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 3 filling/access) <br /> 30� 7 i <br /> 54(9 ❑ Revie ti n Survey <br /> ESTIMATED CONSTRUCTION COST: -+ -+ <br /> -+ ♦ ♦ ♦ $ 450 000 and i options. <br /> (Please round to nearest dollar) <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes aoppon't know <br /> 2. Is there a wetland or floodplain on or near the property? ✓❑Yes Flo DJon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ao <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) Ores 'lo ODon't know <br /> 7. Is this to correct a violation? Des 'lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► -+ <br /> 545-112(Moe) <br />