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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 /> Darryl & Kelly Chlebowski <br /> A _ I <br /> OWNERADDRESS (Number,Street,City,State,Zip) , 54' <br /> Zoning Status; CUP; <br /> 7197 Welford Place,Sun Prairie,WI 53590 �' 'Deed Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)842-2019 (608)575-8837 darryichlebowski @gmail.com _4 Site Plan drawn to scale" <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions 0 <br /> / <br /> AGENT NAME CONTRACTOR NAME L� V <br /> Homeowner ETSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 14 Setbacks 3 ti 0730*a <br /> PHONE PHONE Site Plan approval from 1 ! / <br /> applicable township. ivi <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Al Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 0 <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of property <br /> ❑PARCEL 012/0911-183-0243-0 A-1 1.14 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT • C A/ A/C_— <br /> • Bristol the t S/1 x/4'/4. Driveway perm,, <br /> ADDRESS: (state,county, <br /> 7197 Welford Place <br /> CSM: LOT 23 SUBDIVISION BLOCK/LOT permits <br /> 23 (public <br /> c'-- Winfield Estates --- <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / <br /> Expand existing deck to east to meet house ' Zoning District <br /> ❑This project is a new building or structure. Permitted Use? 0 K <br /> 4 This project is an addition/alteration to an existing building or structure. e� <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Add - A ddy\ <br /> W �yt, <br /> EER d/�BEPTIC (new/ <br /> HEIGHT IN FEET: 6 NUMBER OF STORIES: (Not including basement) <br /> / "kW- I loodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> o •• (attachment) /✓/�— <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rosionControl permit <br /> BASEMENT: 1ST FLOOR: Alf <br /> + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, TA <br /> / <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 326.0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ (/ 1.9 O /�0 end available options. A/ <br /> (Please round to nearest dollar) ` / If <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes Bo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes LINo <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) Elves ElVo ['Don't know <br /> 7. Is this to correct a violation? [Yes lalo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -+ <br /> 545-112(4/08) <br />