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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# ,
<br /> PROPERTY OWNER INFORMATION
<br /> CUSTOMER TO PROVIDE
<br /> OWNER NAME
<br /> Scott& Jennifer Bush
<br /> oning Status;CUP:
<br /> 6Wri-ee Aobef.ss •tre•t,Clii,Staie.Zip)
<br /> Deed Restriction,GSM
<br /> 90 N,Hay Hollow Road,Mt.Horeb,WI 53572
<br /> Varian )
<br /> HomE,''4;oNg—. •---— CELL PHONE 78-MAh.ADDRESS
<br /> (608)523-1270 sbush@tds.net e Plan drawn to scale
<br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Eric W.Olson E.W.Olson Hoono#41AD Iti Site Plan including location
<br /> AGEN T At:CRESS CONTRACTOR ADDRESS iif well/septic
<br /> 301 Corbin Drive
<br /> state,Zp) R.-- .-.-- -------___,
<br /> 1
<br /> i Sarneveld,WI 53507
<br /> PHONE 'PHONE —' Site Plan approval froni\
<br /> (608) 669-5118 (608) 924-1900 applicable township. )
<br /> .. ... _
<br /> E-MAit ADDRESS i E-MAIL ADDRESS
<br /> ericeewolsonttornes.com i ewohiewolsonhomes.com pr-oor• -ie. a scale
<br /> PROPERTVLOCATION INFORMATION (httpataccessdano.co.dano.wLusf)
<br /> _pAREN7 MB i PARCEL NUMBER: CURRENT ZONING 'ACREAGE Ell evation of property
<br /> Li PARCEA . 044/0506-333-9570-9 1 RH-3 ! 12.11
<br /> frontage drawn to scale
<br /> NU --....,..
<br /> t' .'p ISECTION
<br /> Perry I 33 %. SW "1/41/t: SE NI Drive . ,. • its
<br /> ___..........„.„„............. .......______„,,, at- sun . town)
<br /> ADDRESS.
<br /> 90 N. Hay Hollow Road, Mt. Horeb, WI 53572
<br /> ■ ,nit: ..-rmits
<br /> csm (.01 'St3BDIVISION IBLOCO.OT
<br /> (publi ,pn,tter--
<br /> 9,104 1 N/A f• , ,
<br /> i N/A
<br /> PROPOSED PROJECT INFORMATION SJAFF - * IIM
<br /> pRoJECT DESCRIPTKNN
<br /> Foundation Replacement,Additions,and remodel Zoning District
<br /> E]This project is a new building or structure.
<br /> C.1420,14ted Use
<br /> fg This project is an addition/alteration to an existing building or structure.
<br /> Likfr------
<br /> SANITARY SERWCE 'PERMIT NUMBER
<br /> 1
<br /> FIENER rai.EPTC , ( 4.•.-
<br /> . '
<br /> HUGHT IN PEET ,NUMBER Of STORtES (Nat IncludeV basernerm
<br /> 24.0 2.0 8 , ' 1 's ,e:■a pia -, . ...---.
<br /> AREA TO NEAREST SQUARE FOOT rA1-2(
<br /> . . .
<br /> tOtitside dimensions inciuding unfinished area,attached garages and above grade decks or portheS) „.;':;,:'',.:, , moot... C) 1 I 1
<br /> BASEMENT - i 1ST FLOOP i
<br /> 1,310.0 696.0 woos-disturbance
<br /> i 4,TOTAL SQUARE FOOTAGE:. , .--,;-.- .. ! ,
<br /> 1
<br /> 2NO FLOTTR' ;3RD FLOOR ' .
<br /> Revi.:, .f-- .'•n Survey
<br /> ESTINIATED CONSTRUCTION COST $ 130,000.00 ir av,,,, .-1,e options.
<br /> (Please round to neatest dollar) "4' -4* .4* ''. .".' "4' im i
<br /> 1 The property is within 300 feet of a stream or 1000 feet from a pond or lake? _...._,.. E3Yes DNo DDon't know
<br /> 2, Is there a wetland or floodplain an or near the property', 0Yes o DDon't know
<br /> 3. Have you talked with the township about your project and are they in agreement?.... [Yes Ro
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years?„....,. ..., D'es Clio
<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 E-140 3)on't know
<br /> 7 Is this to correct a violation'? [ales a°
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -e. -a, -dr
<br /> 4!•,-.1/2(4.V.:
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