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PROPERTY OWNER INFORMATION <br /> OWNER NAME 41,00 1 vmc.■ ... . .__ _.- <br /> Andy and Kristin Davis 1-1 <br /> HOME PHONE CELL PHONE E-MAIL ADDFttoo <br /> (608)260-5038 (608)279-8838 andy773492 @gmail.com L:J Site Plan drawn to scale I <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> 14 0 r4,-t-, I)c- $5 h cd W '00 jd f✓a <br /> AGENT ADDRESS _ _ <br /> W4819 Pembridge Tr <br /> (City,State,Zip) (City,State,Zip) I rj Setbacks I <br /> II....��1I11 F•ICCC <br /> PHONE rnv1'... <br /> (608) 776-9z•I z aNY1........ . , <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> homedesignsolutionsinc @hotmail.com ®Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION , .• - - - • - • - • • - • - . - - _- <br /> PARENT PARCEL NUMBER: CURRENT Z NING: /+l rtcn�a�. <br /> ElPARCEL ©6.�� Mil©r/�© 3.77 trontage utaWi1 w.2,,,...,. <br /> NUMBER CJ� !l //77 <br /> TOWNS ^�-�� <br /> SEC t: <br /> �,�.(� 1 r 20 '/a: W Ya'/a: NI Driveway permits <br /> ADDR e Otate,county,town) <br /> Lot 1 Blue Maucds Rd job zD U' ilwt <br /> ®Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 4,027 1 na na (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Ho ,4 Li Zoning District <br /> . IN This project is a new building or structure. .. Li Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMI#ER: ❑ Rural Address <br /> EWER [EPTIC )3- Z.--r, —0o3(2 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basemen <br /> 25.0 2.0 LI Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: .,fin �$ Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or p rc es) <br /> BASEMENT: 1ST FLOOR: �� r "" ❑ ErosionControl permit <br /> 858.0 I jO.V ))e5 j TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 850.0 3RD FLOOR: 2r5667€ 3 2 I S filling/access) <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) '♦ "' ♦ —' ♦ ♦ $ 246,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes .✓ Jo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes o ]Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q1'es Do <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0Yes ✓No <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) 0Yes alo ['Don't know <br /> 7. Is this to correct a violation? Oyes ✓N° <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —o. -4 <br /> 545-112(4/08) <br /> 1 ti <br />