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Z014 NG PERMwww.countyofdane.com APPLJCAI1ON wwcountyofdanacom SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME / / <br /> R 1 CCt1 I4 12 LOC' 5 / '4L PE Z2(Vb(PlO ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 833 Dane Street, (town of) Madison, WI 53713-1204 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 258-8613 bonomo@tds.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> (none) (none) ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,Stale,Zip) ❑ Setbacks <br /> PHONE PHONE ❑ Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> SFR-08 ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 111 PARCEL 0709-352-0752-4 R-3 DCPREZ-Qjj 0.138 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Madison -3 5j 1 ': N lij 1/q1/q: ICL_ ❑ Driveway permits <br /> ADDRESS: ` (state, county, town) <br /> Y3� P4IvI >71 (t2I's-r /'lit2 <br /> 00 /.cN oVI 5-1 I t 3 ❑ Sanitary permits <br /> CSM: LOT 24 SUBDIVISION BLOCK/LOT Oak Ridge 2 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: (. f FACTO T IMr 0 K`i-E/27/)tV L_ P -Zol (_00,°41.6 <br /> Replacement of rear porch near end of life with a larger deck ❑ Zoning District <br /> . ❑This project is a new building or structure. 8`X 9' DECK ADDN <br /> () (�] EXPIRED) <br /> LI Permitted Use? <br /> This project is an addition/alteration to an exist�r gtmiming4ot <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> EWER FIEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ,1-3 i`Z 1 ❑ 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 /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: �y � <br /> N/A 1�l/!9 +, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: 74 filling/access) <br /> p:$flsg.ft. (+ steps) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ► and available options. <br /> —0' ♦ -- <br /> (Please round to nearest dollar) —1' ♦ $ 1,500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Efres [2:1No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? fres [ZNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres ZNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres ZNo <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) Ekes IZ1No ❑Don't know <br /> 7. Is this to correct a violation? Ekes ®No <br /> APPLICATION MUST BE SIGNED <br /> 54e-112(4/08) (Continue on Back) —I. —i. —i. <br />