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3' 77 I <br /> ZONIN PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER N• E <br /> Brian Halvensleben <br /> El Zoning Status;CUP; <br /> OWNER ADD'ESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 4370 Be Grass Court Variance(# ) <br /> HOME PHON CELL PHONE E-MAIL ADDRESS �j �( <br /> (608) 3e5-8445 brhhaw @yahoo.com ❑Site Plan drawho 1calt' <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAM: CONTRACTOR NAME <br /> home owner ❑Site Plaiipreation <br /> AGENT ADD' SS CONTRACTOR ADDRESS of w,elll/ p• <br /> (City,State,Zi.) (City,State,Zip) ❑Secg ks <br /> PHONE PHONE ❑Site PI, . •;oval from <br /> appli ; , t. Ti,ship. <br /> E-MAILADDR SS E-MAIL ADDRESS <br /> ❑Floor plc to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Eleva '• 1'�` •roperty <br /> ElPAREN PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> FARCE 068/0910-293-6375-0 t'' Ri—�' 0.31 front. t. ,r.wn to scale. <br /> NUMBS• <br /> TOWNSHIP: SECTION: <br /> • Windsor 9 %: N10E +/4+/4. 29 ❑Driv- � ; •-rmits <br /> ADDRESS: <br /> (sta .44!'' <br /> , .•, nty,town) <br /> • 370 Bent Grass Court <br /> CSM: LOT 35 SUBDIVISION BLOCK/LOT ❑San'p / • • its <br /> Prairie Creek <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DE CRIPTION: <br /> Deck ❑ Zoning[tact <br /> . <br /> This p •ject is a new building or structure. ❑ Permitte0se? <br /> CSI This p eject is an addition/alteration to an existing building or structure. <br /> SANITARY SE'VIC : PERMIT NUMBER: ❑ Rural Ad.•'ss <br /> r.2, R ,!-' • IC (neWie C.) <br /> HEIGHT IN F T: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wletlan• •plain/ <br /> Shorel:1, �.. :chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside di ensions including unfinished area attached garages and above grade decks or porches) ❑ Erosi• ntrol permit <br /> BASEMENT: 1ST FLOOR: 1 TOTAL SQUARE FOOTAGE: 4, (sl0• . a.., • •-fCe, <br /> filling access) <br /> 2ND FLOOR: 3RD FLOOR: q <br /> 1. L ❑ Re ' • ., on Survey <br /> ESTIMATE B CONSTRUCTION COST: and =p'( " e• pnS. <br /> (Please ro d to nearest dollar) ♦ • ♦ ♦ ♦ • $ 2,300.00 <br /> 1. The pro. -rty is within 300 feet of a stream or 1000 feet from a pond or lake? Efres EINo ['Don't know <br /> 2. Is there : wetland or floodplain on or near the property? Ekes ONO 0 Don't know <br /> 3. Have yo talked with the township about your project and are they in agreement? [Yes ao <br /> 4. Has the - been a zoning permit issued for this property in the past 5 years? Dies 'lo <br /> 5. Is this p'eject associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a lo .I ion survey required? (see reverse)... / Elves ✓[lNo ❑Don't know <br /> 7. Is this t• correct a violation? ( [Yes ✓Jlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) 1 <br />