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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION C -.TOMER TO PROVIDE <br /> OWNER NAME <br /> Todd Kubly <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 7 Z ing Status;CUP; <br /> ed Restriction;CSM <br /> 7172 Norway Road Sun Prairie,WI 53590 riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)215-7932 todd©kublyproperties.com ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AG NT NAME �/ CONTRACTOR NAME <br /> iv C As c Euro-American Design&Building ite Plan including location <br /> AGEN DRESS CONTRACTOR ADDRESS f well/septic <br /> 2935 S.Fish Hatchery Rd., <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Madison WI 53711 <br /> PHONE PHONE ❑Site Plan royal from <br /> (608) 308-2023 appli a towns • . <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> euroamerican@charter.net ❑ loot p s to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> lig PARCEL 012/0911-184-9670-0 A-1 1.66 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTI M.' <br /> Town of Bristol S2_ 1/a. 5 E. 1/,,1/:S� ❑ Driveway rmits <br /> ADDRESS: (state ounty,town) <br /> 7172 Norway Road Sun Prairie, WI 53590 <br /> CSM: LOT SUBDIVISION BLOCK/LOT 1=1 S- Itary : m11tS <br /> a 5755-. 2 •ubl'•,private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Building 30'x35"deck • oning District <br /> 0 This project is a new building or structure. t <br /> Perm • to -c? <br /> This project is an addition/ Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: N. ❑ Rural <br /> EWER 1 EPTIC (new/' '-.. • <br /> HEIGHT IN FEET: -I- <br /> cf=..- NUMBER OF STORIES: I(Not uding basement) ID WetlandiF in/ <br /> AREA TO NEAREST SQUARE FOOT: Short (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) it <br /> BASEMENT: 1ST FLOOR: OS M ❑ E(slopes, ivn •= <br /> U + TOTAL SQUARE FOOTAGE: j (slopes, Dance, <br /> 1 filling/: ---- ) <br /> 2ND FLOOR: 3RD FLOOR: 0'S ^^� <br /> U '�` J ❑ Review Location Survey (s\ <br /> ESTIMATED CONSTRUCTION COST: .+ ♦ ♦ ♦ -+ -+ and available options. <br /> (Please round to nearest dollar) $ 3,010.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓alo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes E o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓❑Yes Vo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Efres lalo <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 E�lo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes Ilo <br /> 545-112(4/08) -7- APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> a� <br />