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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Tim and Julie Last 4 l 1 <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 0 Zoning Status;CUP; <br /> Deed Restriction; CSM <br /> 3610 Country Grove Dr Madison, WI 53719 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-469-4799 tmlast @gmail.com Site Plan drawn to scale / <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions il <br /> AGENT NAME CONTRACTOR NAME <br /> Sugar Creek Homes, LLC(Tim Burke) ig Plan including IOCatiO <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 237 Ridge View Trail <br /> (City,State,Zip) (City,State,Zip) IN Setbacks 3 3Q 2s/ct <br /> Verona,WI 53593 <br /> PHONE PHONE i:.1 Site Plan approval from -(f <br /> 608-658-1127 ' -•plicable township. Jv(/ <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tim.burke @sugarcreek-homes.com 0 Floor plans to scale /�X./j <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property // V <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL R 054/0607-264-9330-9 A-1 'j 172-6 frontage drawn to scale <br /> SECTIO ' <br /> Spri gd IP: le <br /> 2 <br /> T Y4: 5 E '/4%a: W IN Driveway per <br /> DDRESS: OK . �� j /5 (state,coup town) <br /> 1Rd Verona,WI 53593 <br /> Sanita ._- <br /> . LOT SUBDIVISION BLOCK/LOT <br /> (publi ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: t <br /> Single Family New House Zoning District A - <br /> . 0 This project is a new building or structure. Permitted Use? 5 C if <br /> ❑This project is an addition/alteration to an existing building or structure. 1 ^- i <br /> SANITARY SERVICE: <br /> EWER EPTIC PER UMBfi�: O1. -1O 3 3,6 > (newl xishng) ©,_S <br /> HEIGHT IN FEET: / NU BER OF STORIES: (Not including basement) <br /> Z 7i one Wetland/Floodplain/ r <br /> Shoreland (attachment) A rt <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) gfrosionCOntrol permit <br /> BASEMENT: 1ST FLOOR: /�r"--A , 1 PI <br /> 2,306 3,800 + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, Uf jJ- JU/U '"; <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 6,106 <br /> \ner-r <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ 400,000.00 and available options. I �j <br /> (Please round to nearest dollar) 1{ /�#� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes I'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes 7lo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes 'lo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 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) ❑Yes Ilo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓11Vo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> S\5 D ?, K-- (Continue on Back) —► <br />