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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 /> Heffron Company ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2000 Prairie Street,Prairie du Sac,WI 53578 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)643-8525 heff@heffronhomes.com ❑ Site PI n wn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and in es dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dan Heffron,Jr. Heffron Homes, Inc. ❑ Site PI n ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/ ptic <br /> 2000 Prairie Street 2000 Prairie Street <br /> (City,State,Zip) (City,State,Zip) ❑Sets <br /> Prairie du Sac,WI 53578 Prairie du Sac WI 53578 <br /> Site <br /> PHONE ❑ rom <br /> (608) 644-3911 PHONE (608) 644-3911 applica. I./ ,ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> heff@heffronhomes.com heff@heffronhomes.com n Floor planscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Elevationproperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 111 PARCEL 050/0907-184-3067-0 5 � 1 • r9(pP'- frontage rawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Roxbury 1/4: 1/4: ❑ Drivew ermits <br /> ADDRESS: (state, county,town) <br /> CS(/9`/�,/, Flyhawk Lane <br /> M: LOT SUBDIVISION BLOCK LOT [' Sanitary permits i 1 1 y <br /> 7 Blackhawk Fields (public, private) I�dSy <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zonin lstrict <br /> . riThis project is a new building or structure. ❑ PermVt1 Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: - ❑ Rural Address <br /> EWER rEPTIC Mr/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 20.3 1/ 1.0 Li Wetland/Floodplain/ <br /> Shoreland (attachmeftt) <br /> AREA TO NEAREST SQUARE FOOT: J / '' ll <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) of IG <br /> BASEMENT: ' 1ST FLOOR: ' / ❑ ErosionControl permit <br /> 1 863.0 ✓ 3 539.0 v ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) >2,)v 1 <br /> 3,539.0 ❑ Revi w ;:#5 :31n tiS ey <br /> ESTIMATED CONSTRUCTION COST: Q and a ( tl <br /> (Please round to nearest dollar) ♦ ♦ ♦ $ 410,000.00p ((k SZ,�ce <br /> I1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? IYes nNo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes ,No [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? (✓Yes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes 0No <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 ❑No ❑Don't know <br /> 7. Is this to correct a violation? EYes nNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) — -* -i <br /> REV(01/19) <br />