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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 /> Andrew & Kelsey Eyers [zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5421 Day Tripper Dr.,Madison WI 53718 Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> (715)308-9657 sfrohling @tobhomes.com <br /> Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Sue Frohling TIM OBRIEN HOMES Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 4868 High Crossing Blvd. 4868 HIGH CROSSING BLVD <br /> (City,State,Zip) (City,State,Zip) ' Q Setbacks <br /> Madison,WI 53704 MADISON,WI 53704 ��/ <br /> PHONE (608) 661-1100 PHONE (608) 661-1100 ooval f <br /> rom <br /> township. <br /> E-MAIL ADDRESS EMAIL ADDRESS <br /> sfrohling @tobhomes.com sfrohling @tobhomes.com Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> 0 PARCEL 012/0911-303-63150 A-1 0.69 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: Driveway Town of Bristol(012) 30 1/4; SE %1A. SW y permits <br /> (state,county,town) <br /> ADDRESS: <br /> Lot 15, Bristol Gardens 3oS9 LA-(0444,1's a -1 <br /> Q Sanitary permits <br /> CSM: LOT 15 SUBDIVISION BLOCK/LOT (public,private) <br /> Bristol Gardens <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: Er <br /> SINGLE FAMILY HOME oning District <br /> . <br /> This project is a new building or structure. t� Permitted Use? <br /> EThis project is an addition/alteration to an existing building or structure. _ <br /> SANITARY SERVICE: PERMIT NUMBER: Li R Address <br /> EWER SEPTIC OP-xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 23.0 1.0 l Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: L Eros onControl permit <br /> 2,212.0 3,056.0 + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> p filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 5,268.0 <br /> CI Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available 0 tions. <br /> (Please round to nearest dollar) ♦ ♦ —P -+ ♦ $ 273,745.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes No ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes FNo QDon't know Q 3. Have you talked with the township about your project and are they in agreement? Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes 7 o <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) ✓QYes DM) ['Don't know <br /> 7. Is this to correct a violation? Dies ✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -+ -+ <br /> 545-112(4109) <br />