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1+ 1 24 � c <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Gary Pelletier D Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zip) <br /> Deed Restriction;CSM <br /> 6623 Longhorn Lane Variance(# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> (608)825-1985 I, (608)445-2080 gpelletier66@gmail.com Q Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Patio Pleasures ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 622 W Main St <br /> (City,State,Zip) (City,State,Zip) D Setbacks <br /> Sun Prairie,WI 53590 <br /> PHONE PHONE ['Site Plan approval from <br /> (608) 825-6200 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> D Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El <br /> ig PARCEL 0911-293-4248-0 A-1 0.73 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP. SECTION: <br /> TOWN OF BRISTOL 29 +/4: SW +/4+/4: SW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 6623 Longhorn Lane, Sun Prairie, WI 53590 <br /> CSM: 2 48 LOT o SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> °t0 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: � <br /> In ground swimming pool ©A/1 id 0 _ ❑ Zoning District <br /> . 151 This project is a new buildrro structure. <br /> Ca Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> [)EWER PEPTIC .J (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> ...--_ AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erasion0orltro1 permit <br /> BASEMENT 1ST FLOO n n <br /> -/`Y`J j, TOTAL SQUARE FOOTAGE: j ( pD3,CGStUt178rte@, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> eS$) <br /> 5-Z ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ —* ♦ ♦ -+ ♦ $ 66,035.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ✓D Jo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ✓ o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Des <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes Elo <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) Dyes alo ['Don't know <br /> 7. Is this to correct a violation? Dyes al <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► <br /> 545-112(4109) <br />