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. „ n <br /> \-;--e/C° , ( _ty, , <br /> 1L.)-- (7.--) 6-411 <br /> 4- <br /> (R.\&-,GC`t\ A-C) _ '' f , <br /> Z ING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-kpp <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PR•VIDE <br /> OWNER NAME Richard & Mary Fahey ,Tt <br /> . ❑Zoning S to ; +1-, <br /> OWNER ADDRESS(Number.Street,City,Slab,Zp) Deed ' <br /> 1984 Manhattan Drive,Verona,WI 53593 Varian (# ) <br /> HOME PHONE 'CELL PHONE E-MAIL ADDRESS <br /> (608)212-5711 mfahey@brucecompany.com ❑Site Plan s.:le <br /> AGENT INFORMATION 1 CONTRACTOR INFORMATION and include mensl. S <br /> AGENT NAME CONTRACTOR NAME <br /> Terrace Custom Builders ❑Site Pia Inc trig lo..tion <br /> AGENT ADDRESS CONTRACTOR ADDRESS of weli/s c <br /> 1553 11th Drive <br /> (City.State.Zip) (City.State,Zip) ❑Se CS <br /> Friendship,WI 53934 <br /> PHONE PHONE ❑Site a royal fro <br /> (608) 339-7888 app) e s yip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> terraceoffice @terracehomes.com ❑Floor plan t scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) ❑Elevation Of Ity <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0508-293-9500-8 A-1 38.00 frontage d to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: I <br /> Town of Montrose +/: SW yy4; 29.5N.eE ❑Drivew-al.:• may <br /> ADDRESS: (state. •f•un t,tON47,I % �• <br /> 7532 Walter Road, Belleville WI 53508 Ci `j' / <br /> CSM: LOT -SUBDIVISION BLOCK/LOT ❑Sanitary perm I <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW I <br /> PROJECT DESCRIPTION: <br /> Remand and npYc.m.m a an wrtYq house ailh Is now haws berg le.s ern too reel away from M.addling Muse ❑ 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 Add ess <br /> EWER PEPTIC 13,201,500,193 (new/e ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not Including basement) <br /> r 0- 1.0 ❑Wetiand/Floodplain/ <br /> Shoreland (attachmen <br /> AREA TO NEAREST SQUARE FOOT: __— — <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ErosionControl permit <br /> BASEMENT: ST FLOOR n� TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 1,847.0 2,740.0 7" '1 4, (slop filling/access)u <br /> 2ND FLOOR: 3RD FLOOR: <br /> 4,58770 Vitt 0 <br /> Revie n Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ and a i o bons. <br /> (Please round to nearest dollar) ♦ $ 250,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes [ }o ['Don't know <br /> j/v r e l 2. Is there a wetland or floodplain on or near the property? :Yes RO J)on't know <br /> ` x 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? QYes [lo <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 El•lo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(uoe) <br />