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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App #. <br /> ,Z� a <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME TIM OBRIEN HOMES <br /> ❑Zoning Status; CUP; <br /> OWNERADDRESS (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 sfrohling @tobhomes.com IN Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sue Frohling 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 /> (City,State,Zip) (City,State,Zip) IN Setbacks <br /> MADISON,WI 53704 MADISON,WI 53704 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 661-1105 (608) 661-1100 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Bil <br /> sfrohling @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 /> ❑PARCEL BER 0910-294-2228-0 R-2 0.36 frontage drawn to scale. <br /> NUM <br /> TOWNSHIP: SECTION: <br /> TOWN OF WINDSOR(09) 29 1/4; NW 1/4l/4; SE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> le u Ce 17 kks G Iv <br /> CSM: LOT GQ SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> VO WOLF HOLLOW (public,private) <br /> PROPOSED PROJECT INFORMATION '' �4. <br /> PROJECT DESCRIPTION: i� k ,� <br /> SINGLE FAMILY HOME ,I,., ,;.-.0 .4:, <br /> . al This project is a new building or structure. --,* Z�`§� <br /> This project is an addition/alteration to an existing building or structure. � ., y <br /> SANITARY SERVICE: PERMIT NUMBER: U "' <br /> EWER r)EPTIC M '' <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) , r ' ,� , r <br /> 24.0 ND Al' 2.0 �i �'� ,r,. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: _ ' <br /> 1 ,504.0 p�33b 16.3-1-0 . v j TOTAL SQUARE FOOTAGE: ,, <br /> 2ND FLOOR: 3f hOOR: 1 * s <br /> ESTIMATED CONSTRUCTION COST: t� <br /> (Please round to nearest dollar) ♦ ♦ ..+ .- 'P 197 355.00 <br /> . <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 jNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ❑ <br /> ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Ekes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓❑No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) <br /> ' ,751)%1 <br />