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4-8 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Robert Hostrawser <br /> IN Zoning status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> PO Box 787 Stoughton,WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)213-1807 robhostrawser @gmail.com p Site Plan d a to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includ dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> AGENT ADDRESS CONTRACTOR ADDRESS Cis/Yt.wc J~ p Site ding location <br /> /A04s d:/J.c s r <br /> (City,State,Zip) (City,State,Zip) p a Set s <br /> 4-d 4r,c)N CJL ,5,3S 3 <br /> PHONE PHONE l [Site Playa '�v h.from <br /> - �Y S -/Sc 1 appiica le ;, ns ip. <br /> E-MAILADDRESS E-pg <br /> DDRESS <br /> 4 Floor plans Vale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p Elevation f prope <br /> p NUMBER 002-0512-054-5589-0 R1 r 4 0.54 frontage d o scale. <br /> TOWNSHIP: SECTION: p DfIV2W e <br /> Albion '/a: '/a%a: (state,c o <br /> ADDRESS: <br /> , , � : . , -. Sanitary permits , <br /> r <br /> .... <br /> CSM: LOT SUBDIVISION BLOCK/LOT 1-� <br /> 9,667 Blue Meadow Estates 9 (public, private) �JC <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: i' �/ <br /> New home construction ❑ Zoning LlIS�IIet^ <br /> . p This 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: ❑ 91/Address <br /> FIEINER [EPTIC / 3 a(Y/S - ,')/7 7 existing) <br /> HEIGHT IN FEET: . • ( NUMBER OF STORIES: (Not including basement) <br /> L�� l'�� 2.0 ❑ Wetlan•/F' .: •lain/ <br /> AREA TO NEAREST SQUARE FOOT: ShOrel t� s r hment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion o `t11'- it <br /> 1 ,678.0 3,419.0 j, TOTAL SQUARE FOOTAGE: 4, (slopes,+ -i1l , Ce, <br /> filling/-« - <br /> 2ND FLOOR: 708.0 3RD FLOOR: 5,805.0 <br /> J J ❑ Rev" Locati i Survey <br /> ESTIMATED CONSTRUCTION COST: d, 270,000.00 and i� ''e pti• s. <br /> -+(Please round to nearest dollar) '♦ ♦ ♦ -0 ♦ $ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes Q✓No QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes pNo ['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? Elves NI 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) Q✓Yes ENo ❑Don't know <br /> 7. Is this to correct a violation? QYes Q No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -0 -0 <br /> 545-112(4/08) <br />