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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME TIM OBRIEN HOMES <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4868 HIGH CROSSING BLVD,MADISON,WI 53704 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)661-1100 MREARDON @TOBHOMES.COM <br /> Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> MARILYN REARDON TIM OBRIEN HOMES ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4868 HIGH CROSSING BLVD 4868 HIGH CROSSING BLVD <br /> III <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> MADISON,WI 53704 MADISON,WI 53704 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 661-1100 (608) 661-1100 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> IN <br /> MREARDON @TOBHOMES.COM Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> Elfrontage 0910-294-2290-0 R-2 0.28 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> TOWN OF WINDSOR(09) 29 .1/4. NW 1/41/4. SE ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: <br /> to(12 J-2 Dusky Glen <br /> CSM: LOT 80 SUBDIVISION BLOCK/LOT Sanitary permits <br /> 80 WOLF HOLLOW (public,private) <br /> PROPOSED PROJECT INFORMATION' ) <br /> PROJECT DESCRIPTION: ) � % <br /> SINGLE FAMILY HOME i. c (V. -V pG r.- : f -� " <br /> . 0 This project is a new building or structure. ' 3= <br /> ❑This project is an addition/alteration to an existing building or structure. A# <br /> SANITARY SERVICE: PERMIT NUMBER: a$� -.4 £ Y <br /> EWER [)EPTIC �)' , <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) v <br /> 28.0 2.0 at ' *ktiif v, <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) il,- k ;BASEMENT: 1ST FLOOR: � `901.0 L + TOTAL SQUARE FOOTAGE: �` � ® .,X58. �-g kq"` <br /> 2ND FLOOR: 3RD FLOOR: '' <br /> 1 ,025.0 ni0 2r9 0 <br /> ESTIMATED CONSTRUCTION COST: <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 'p 262 000.00 `- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 15I No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes jNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Oyes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes FINo <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? ❑Yes ✓❑No 1 / <br /> f� , ; (1 '�' APPLICATION MUST BE SIGNED <br /> // (Continue on Back) ♦ -i <br /> 545-112 14/08) V <br />