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o,''.', ` DANE COUNTY <br /> —' ZONING PERMIT APPLICATION WWW.DANE000NTYPLANNING.COM <br /> Ciota PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Paul Werwinski Parcel Number - 028/0610-084-9990-2 <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2703 Tower Rd, McFarland, WI 53558 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 212-7945 (608)212-7945 pwerwinski @yahoo.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Advanced Contracting Solutions, LLC ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 405 Sunset LN <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> Richland Center, WI 53581 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 475-3973 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> PARCEL 0610-084-9990-2 residential 0.26 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Dunn '/4: 1/4: ❑ Driveway permits <br /> (state,county,town) <br /> ADDRESS. 2703 Tower Rd, McFarland, WI 53558 <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Installation of 1 egress window and 1 at grade window ❑ Zoning District <br /> . ❑This project is a new building or structure. ❑ Permitted Use? <br /> NI This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> RIEWER r)EPTIC <br /> (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ 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 4, TOTAL SQUARE FOOTAGE: ,j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 16 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --► '+ ♦ ♦ d� 8 $oo and available 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 ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [.Yes ❑No ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes ENo <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 ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes IgNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ —► <br /> REV(01/19) <br />