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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 /> Zana Bajalan ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 408 Powers Avenue <br /> Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> (414)581-7719 zanajassim@gmail.com n Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Thomas Eveland-Eveland Construction ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 709 School Lane <br /> (City,State,Zip) (City,State,Zip) n Setbacks <br /> Hollandale,WI 53544 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (608) 963-7075 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> evelandconstruction@yahoo.com ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE. <br /> Ti PARCEL 008/0710-051-2811-9 SFR-8 0.124 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Blooming Grove . 1/. ❑Driveway permits <br /> 1/4 <br /> (state,county,town) <br /> ADDRESS: <br /> 408 Powers Avenue, Madison, WI 53714 <br /> CSM: LOT 11 SUBDIVISION BLOCK/LOT - ['Sanitary permits <br /> Galliger Elisha L 6 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Sun room addition W/ DECK AND STEPS ❑ Zoning District <br /> ❑This project is a new building or structure. U Permitted Use? YES <br /> ✓❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: --1 Rural Address EX <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not Including basement) NO <br /> 8.0 1.0 J 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: J ErosionControl permit <br /> _ 251 4, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, NO <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> -168.0- 251 <br /> II Review Location Survey US=AS BUILT <br /> ESTIMATED CONSTRUCTION COST: and available options. SU RVEY <br /> (Please round to nearest dollar) -+ ♦ -' ♦ ♦ -. $ 35,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes Jo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies no ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ElYeso <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [fres ✓❑No <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) [fres llo ❑Don't know <br /> 7. Is this to correct a violation? Elves ['No <br /> $75.10 APPLICATION MUST BE SIGNED <br /> REV(01/19) <br /> (Continue on Back) 4- -+ -4. <br />