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4[00 6 2,00 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Mark & Stacey Ray(currently owned by Don Tierney) <br /> OWNER ADDRESS (Number,Street,City,Stale,Zip) ❑Zoning Status;CUP; <br /> Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS 7( <br /> AGENT INFORMATION CONTRACTOR INFORMATION S Site Plan drawn to scale <br /> AGENT NAME CONTRACTOR NAME and includes dimensions <br /> Sue Frohling _Tim O'Brien Homes of Madison, LL' ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS <br /> Same 2601 Crossroads Dr., Ste 140 of well/septic <br /> (City,State,Zip) (City,State,Zip) 'Setbacks <br /> Madison, WI 53718 _ <br /> PHONE PHONE ❑Site Plan approval pproval from <br /> E-MAIL ADDRESS applicable township. <br /> E-MAIL ADDRESS <br /> sfrohlin• • tobhomes.com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) <br /> r�PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevatlo Of erty <br /> y PARCEL <br /> aKJ NUMBER 0911-303-6304-0 frontage wn to scale. <br /> TOWNSHIP: SECTION: <br /> SE %: SW '/a'/<: ❑Drive�y9yp <br /> ADDRESS: —� (Stat 0 mits <br /> own) <br /> 3051 Lyman's Run, Sun Prairie, WI 53590 <br /> CSM: LOT SUBDIVISION BLOCK/LOT �(publi(public, permits <br /> 14 Bristol Gardens (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> ❑ Zoning vie' <br /> • 12 This project is a new building or structure. <br /> 0 <br /> This project is an addition/alteration to an existing building or structure. Fermi to se? <br /> SANITARY SERVICE: PERMIT NUMBER: rr �Q ❑ oral �,�; —` /� / <br /> EWER PEPTIC V'3 ewl� (TgtI "/( ��jj t-HEIG TIN FEET: �l • NtN�It3ER OF STORIES: (Not including basement) 111 <br /> , !!/111 .24 ❑ Wetla �F�I�d an/ <br /> v AREA TO NEAREST SQUARE FOOT: Shore"WtaJ ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) , <br /> BASEMENT: 1ST FLOOR: / ‘...1 Eros' `rd �t. •ermit <br /> 2224 ice I 4 TOTAL SQUARE FOOTAGE: 4 (sic) es, t bance, <br /> 2ND FLOOR. 3RD FLOOR: filling/access) <br /> 1241 4,750 ❑ Revi ��j <br /> ESTIMATED CONSTRUCTION COST: 3 (�2.p,iL7� 1 t rvey <br /> (Please round to nearest dollar) "� "� '� �► -♦ 45 v and va a I ptlons. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes Selo []Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Res o QDon't know • <br /> 3. Have you talked with the township about your project and are they in agreement? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? JYes 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) Ekes QNo QDon't know <br /> 7. Is this to correct a violation? <br /> [Yes bilic o <br /> APPLICATION MUST BE SIGNED <br /> 545-112 to/oaJ (Continue on Back) —► —► —o. <br />