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"3 988 L 'E%(-D <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Thomas J Brown <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) - <br /> Deed Restriction;CSM <br /> 8494 Stonebrook Circle Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)669-5080 (608)516-7887 kbtbbrown©gmail.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State.Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE 0 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PAR ER: CURRENT ZONING: ACREAGE: ❑Elevation of property <br /> ❑PARCEL (�� 0.50 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> middleton 1/4: 1/1/: 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 8494 Stonebrook Circle <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Deck/Patio ❑ Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> ISIThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r1,71EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 10.0 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> +, TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> (31340 320.0 4-10,`� <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -► -► -� ♦ ♦ and available options. <br /> $ 25 <br /> (Please round to nearest dollar) $ ,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes fDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yeso [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 ✓E ' 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) [Yes f Vo ✓ )on't know <br /> 7. Is this to correct a violation? ❑Yes D■lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► <br /> 545-112(4/08) <br />