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. ■NG PERIVT1 APPLICATION Nwwzco uacon SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOM R TO PROVIDE <br /> OWNER NAME <br /> Mark Ray Z ing Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction; CSM <br /> 2594 Leopold Way Apt 201 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6087125534 meray(a uwalumni.com ❑ •e Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Mark Ray Mark Ray ❑ it Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> (City,State,Zip) (City,State,Zip) ❑ acks <br /> PHONE PHONE Sit Ian approval from <br /> plicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El ion of property L� p <br /> m PARCEL 0911-303494(4k-0 0.696 ntage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: .430.4 ID SECTION: <br /> • Bristol 1/4: WA: ❑Drive ay .ermits <br /> ADDRESS: (state .,•unty,town) <br /> 3051 Lyman's Run <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑San'• --rmits <br /> 14 Bristol Gardens (pub'-, •rivate) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Deck Addition oning District <br /> . 171This project is a new building or structure. Otlyated Use? <br /> ZThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> �`EWER �EPTIC (new/- i • <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> Wei. J1 ..., . <br /> tkipr.AREA TO NEAREST SQUARE FOOT: ShOrelan -chment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Eros!. on • A•ermit <br /> BASEMENT: 1ST FLOOR: + TOTAL SQUARE FOOTAGE: l (slopes, • -'. rbance, <br /> 2ND FLOOR: 3RD FLOOR: filling!- =83 <br /> Review L'cation Survey <br /> ESTIMATED CONSTRUCTION COST: -• -• ♦ -• -• -• �� „ and a - or ions. <br /> (Please round to nearest dollar) <br /> / -.24 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes IZINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes WIVo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [ Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? fYes ao <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 ao IJDon't know <br /> 7. Is this to correct a violation? ['Yes alo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -1 <br /> 545-112(4/08) <br />