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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Kelly Ebert <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2937 Fern Dr Sun Prairie,WI 53590 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (920)412-2002 dosie83 @gmail.com l 4 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ri Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> NI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT Z NING: ACREAGE: <br /> ❑PARCEL 0911-184-9560-3 A,..� 1.00 frontage drawn to scale. <br /> NUMBER I . <br /> TOWNSHIP: SECTION: <br /> Town of Bristol 18 1/a: 9 '/a'/a: 11 ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2937 Fern Dr Sun Prairie, WI 53590 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 1,185 4 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> Chicken Coop « .,I , - <br /> l51 This project is a new building or structure. <br /> ❑This project is an addition/alteration to an existing building or structure. l <br /> SANITARY SERVICE: PERMIT NUMBER: o" <br /> [EWER 1EPTIC IN m <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 6.0 , y , <br /> Orel- e e <br /> AREA TO NEAREST SQUARE FOOT: ,, --1 f `' <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: I ' ® € E,-•- <br /> 48.0 4, TOTAL SQUARE FOOTAGE <br /> 2ND FLOOR: 3RD FLOOR: M <br /> 4 .0 ;; . <br /> LRe �nS <br /> ESTIMATED CONSTRUCTION COST: , ; -4 <br /> (Please round to nearest dollar) "i "� ♦ ♦ ♦ 200.00 "x , ;s <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 QNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? E Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes '4No <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 ❑Dor+'t know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -i -4 <br /> 545-112(4/08) <br />