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�1 G �CA11CN�ieaoultycAcane.corn SUPPLEMENT to Web App # <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME <br /> Dave & Lara Herzog oning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> 7009 Briar Lane, Sun Prairie, WI 53590 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-628-5651 dcherzog(gmail.com ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION a includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Randy Marten Marten Building & Design ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS It well/septic <br /> P.O. Box 64 P.O. Box 64 <br /> (City,State,Zip) (City,State,Zip) S acks <br /> Sun Prairie, WI 53590 Sun Prairie, WI 53590 <br /> PHONE PHONE ❑ ite Pla proval from <br /> 608-212-6934 608-212-6934 le township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> randyamartenbuilding.com randy(a�martenbuilding.com £ationof r plans to scale <br /> PROPERTY/LOCATION INFORMATION (hltp://accessdane.co.dane.wi.usn property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 091119301330 Al .778 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTI O <br /> Bristol P 14: �� 1/41/4: ❑D iveway permits <br /> ADDRESS: tate,county,town) ��� <br /> a\ k S.-.Lary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 13 (p IA' , private) <br /> Parker Pass <br /> PROPOSED PROJECT INFORMATION • AFF REVIEW <br /> PROJECT DESCRIPTION: • <br /> Single Family New Contruction A 1 t r A d- e C., • zoning District <br /> . IZIThis 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: ❑ Address <br /> EWER OEPTIC 13201500076 (new existing) <br /> HEIGHT IN FEET: �� NUMBER OF STORIES: (Not including basement) <br /> 33'-6" 2 ❑ Wetland/F plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shor nd (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionCOntrol It <br /> 1313 2732 j TOTAL SQUARE FOOTAGE: j (slopes,di nce, <br /> 2ND FLOOR: 3RD FLOOR: fIIIIng/ eSS) <br /> 1732 5777 <br /> LI Review Location Surve ,C S <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) —• —• —• • 'w '♦ $ 423,487.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ZJo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes to ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes [ZVo <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 Do ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ZNo <br /> O <br /> �12 APPLICATION •MUST BE SIGNED <br /> 545-112(4/08) A (Continue on Back) ♦ —► -. <br /> ✓✓J <br />