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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Luis Dompablo 4 –/ -l( <br /> Ed <br /> Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM / <br /> 2043 Hawkinson Road,Stoughton Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)279-0835 aluisdompablo©yahoo.com i* Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME �� <br /> Nic Hauser Hauser Hills Construction Site P -. '•_ uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • w- I/septic <br /> W7290 Farmers Grove Road W7290 Farmers Grove Road <br /> 3/70 5p/- -0 <br /> (City,State,Zip) (City,State,Zip) ErSetbacks <br /> New Glarus,WI,53570 Monticello,WI,53570 <br /> PHONE PHONE Site Plan approval from /i /m / <br /> (608) 445-7994 (608) 445-7994 applicable township. , <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> nicmhauser@yahoo.com nicmhauser @yahoo.com ► Floor plans to scale /4 1 PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING fa <br /> ri PARCEL 028/0610-281-8710-3 A-1(EX) 4 31.08 frontage drawn to scale <br /> NUMBER <br /> TOWNSHIP: SECTION , / 1,,,/ <br /> Dunn "Z 'A: A/ 1/%: A Driveway pe =c1.- <br /> ADDRESS: (state,coons , own) <br /> 2043 Hawkinson Road <br /> CSM: LOT SUBDIVISION BLOCK/LOT (� (pub -. ,_ <br /> .�— (pub �•i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: /� <br /> New Home Construction, e existing home tg Zoning District A ^ f <br /> This project is new buildin r structure. Pe Ube? i�t I):(2,-)(0 <br /> ❑This project is an addition/alteration to an existing building or structure. n <br /> SANITARY SERVICE: PERMIT NUMBER: Rtxal Add( Fe <br /> EWER JEPTIC 40;492—/ ens 'L 0/ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement)6'0 0 pV <br /> ....1976 3 2.0 : l <br /> • t E,, (attachment) /ti id- <br /> AREA TO NEAREST SQUARE FOOT: / <br /> (Outside dimensions including Pished area,attached garages and above grade decks or porches) ,R,('_� CDntrd permit 7a App/r <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: G�((SlOpes,disturbance, <br /> 1,140.0 2,436.0 j filling/access) <br /> 2ND FLOOR: 62g,0 3RD FLOOR: <br /> 4,240 0 <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available s. 4_ <br /> (Please round to nearest dollar) -+ ♦ ♦ ♦ —+ ♦ $ 270,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Wes ✓ 'o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes �o ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Efres No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes ONo <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) DYes DNo DDon't know <br /> 7. Is this to correct a violation? Dyes 1/I ° <br /> (ç) <br /> +1 - c_ v 6 APPLICATION MUST BE SIGNED <br /> (Continue on Back) — <br /> 545-112(4/08) `."t 1 '.. /,r (P� <br /> a b 1 jj rov_,,,i_ e.-ri c)-,-- <br />