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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <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 /> ig 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 /> (City,State,Zip) (City,State,Zip) 0 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 /> MREARDON @TOBHOMES.COM 0 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 0910-294-4022-0 R-2 0.47 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> TOWN OF WINDSOR(09) 29 1/4. SW 1/41/4. SE ❑Driveway permits <br /> (state,county,town) <br /> ADDRESS: 66 y DUSKY GLEN <br /> CSM. 13,792 LOT 274 SUBDIVISION BLOCK/LOT <br /> 151 <br /> Sanitary permits <br /> WOLF HOLLOW (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> SINGLE FAMILY HOME ❑ Zoning District <br /> . IgThis 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: ❑ Rural Address <br /> PIEWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: - NUMBER OF STORIES: (Not including basement) <br /> � <br /> 28.0 2.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages ar.34 above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 7-9 ❑ ErosionControl permit <br /> 1121-37°- 2,101 .0 Z j TOTAL SQUARE FOOTAGE: 1 (slopes,disturbance, <br /> ��z8 ' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 ,314.0 .4,-628 Q3� <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ '♦ ♦ $ 297,800.00 <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 ['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? DYes ❑✓No <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 ✓INo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />