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SUPPLEMENT to Web App #ZONI G PERNIT APPUCATION vwwkccourtyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jeremy & Shyla Duckart <br /> El Zoning Status; P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re rict n;CSM <br /> 3315 Nelson Rd, Sun Prairie, WI 53590 Variance( ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-209-9065 jduck(a�yahoo.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Randy Marten Marten Building & Design ❑Site Plan i c ding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> P.O. Box 64 P.O. Box 64 <br /> (City,State,Zip) (City,State,Zip) ❑SetL is . <br /> Sun Prairie, WI 53590 Sun Prairie, WI 53590 V/ <br /> PHONE PHONE ❑Site Plan ro .f( ;■ <br /> 608-212-6934 608-212-6934 applicablltov 'p. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> randy(a�martenbuilding.com randyamartenbuilding.com ❑Floor plaV5'scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us� ❑ Elevatio �o roperty <br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE: <br /> ❑PARCEL 091119206010 l� .970 frontage awn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Bristol 19 1/4: NE 1441/4: NW ❑ Drivew y <br /> ADDRESS: (stat town) <br /> CSM: LOT 040 � 5 B O(. ❑Sanitary er I^ <br /> cs o 21 SUBDIVISION (public,p ' e) � Jed 1f\ <br /> Norway Estates <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family New Contruction ❑ Zoning <br /> This project is a new building or structure. ❑ Permitt <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> IEWER 7EPTIC 13-2015-00159 (r> nr/existing) <br /> HEIGHT IN EET: 1 NUMBER OF STORIES: (Not including basement) (J <br /> �j 21 1 ❑ Wetla . ••.•ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore)`' •. (•/7"+' ment) <br /> (Outside dimen s including unfinished area,attached garages and above grade decks or porches) <br /> ( 9 9 9 9 P ) <br /> BASEMENT: 1ST FLOOR: ❑ Ero •n O tf01 Tmlt <br /> 1976 4213 4, TOTAL SQUARE FOOTAGE: ,, (si0.1! , nce, <br /> filling/acc <br /> 2ND FLOOR: 3RD FLOOR: <br /> 6189 <br /> ❑ Review Li r - 1i Ay ey <br /> ESTIMATED CONSTRUCTION COST: and avail& le .1 in-. <br /> (Please round to nearest dollar) ♦ ♦ ♦ '� 429,355.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IZIVo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes slo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? WlYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 17 io <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 alo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [ to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -i <br /> 545-112(4/08) <br />