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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 /> Karen M Kvalo ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7385 Norway Road Deforest Wi 53532 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)345-6077 ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Daniel Waldner Waldner Construction Inc ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> P O Box 1103 SAME AS AGENT <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Sun Prairie Wi 53590 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 235-4371 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> danieljwaldner @yahoo.com ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> i PARCEL 012/0911-181-9250-0 A-1 tj t.00(i frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town Of Bristol 18 1/4: 1/1/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 30 2_3 Lawrence Lane <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> /04)5.5 I N/A (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Construction Home ❑ Zoning District <br /> . 0 This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC 13,201,600,266 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 22.0 1.0 ❑ Wetland/F000dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 2,357.0 1ST FLOOR: 3,719.0 + TOTAL SQUARE FOOTAGE: ,, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 6,076.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available Options. <br /> $ <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ '♦ ♦ 365,000.00 <br /> 4 505.Iv <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes 'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes Olo <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) [Yes ao ❑Don't know <br /> 7. Is this to correct a violation? [Yes ao <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545-112(4/08) <br />