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• <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME JUSTIN MCBRIDE & COURTNEY MORGAN <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 107 RIVERSIDE DRIVE, MADISON WI 53704 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (815)955-2548 JUSTIN@CCHOFWAUNAKEE.COM ❑Site Plan drawn to scale ^ ,� p) <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions l� <br /> AGENT NAME CONTRACTOR NAME <br /> • CLASSIC CUSTOM HOMES ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 401 N. CENTURY AVENUE <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> WAUNAKEE,WI 53597 <br /> PHONE PHONE ❑Slt P a n royal from <br /> E-MAIL ADDRESS E-MAIL ADDRESS (608) 850-4450 apnship. <br /> NICOLE@CCHOFWAUNAKEE.COM ❑Floor``plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:llaccessdane.co.dane.wi.us/) ❑Elevation of r erty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 090636196500 (2..R4 5.25 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> MAZOMANIE 36 1/4: SE %/4: NE ❑Driveway permits <br /> ADDRESS/@ SHOWER ROAD (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 13,518 1 N/A N/A (public,private) Z <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> SINGLE FAMILY RESIDENCE ❑ Zoning District <br /> ['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: U Rural Address <br /> EWER [EPTIC 13,202,100,186 Of/existing) <br /> HEIGHT FEET: ( NUMBER OF STORIES: (Not including basement) <br /> tiVA.A ri23.0 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland,(attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 1,880.0 1,906.0 4, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/aCveSS) <br /> 0.0 0.04,906.0- <br /> 3�� 13 Reviewt.Lfitc,stion Survey <br /> ESTIMATED CONSTRUCTION COST: $ and avAil b e options. <br /> (Please round to nearest dollar) ♦ ♦ —' —' —P —' d' 523,361 .00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ❑✓No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [fres ENo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes QNo <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 ENo EDon't know <br /> 7. Is this to correct a violation? ❑Yes ENo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► - -+ <br /> REV(01/19) <br />