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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME <br /> Jonathan R. Novotny I / <br /> azoiing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) lamed Restriction; CSM <br /> 3891 Birch Trail, Cross Plains, WI 53528 , ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS / <br /> (920)427-7848 novotny.jon @gmail.com EA SoPlan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION rd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> El Site/f6Ian including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of.well/septic <br /> (City,State,Zip) (City,State,Zip) 4etbacks <br /> PHONE PHONE ❑Site Plan apy S i from <br /> plicablo-township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P y <br /> 12 PARCEL 070723197400 RH-1 3.13 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Cross Plains 23 1/4, XNE14- 4. $E ❑ Driveway mits <br /> ADDRESS: (state unty,town) <br /> 3891 Birch Trail, Cross Plains, WI 53528 /,/ <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary RIIiS <br /> 10,144 2 (publi , rivate) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: � �' *� � <br /> Attached 520 sq.ft. deck addition, first level. ; t, � V <br /> x 74. - <br /> . <br /> This project is a new building or structure. MAR 1 � 21 .' <br /> 12 This project is an addition/4/teration to an existing building or structure. � - <br /> SANITARYSERVICE: PERMIT NUMB-. pi*MG&* " t` "y __ <br /> M.EWER 0-EPTIC N DANE comi� ,i.,` -� <br /> HEIGHT IN FEET: NUMBER OF STa RIES: (Not including basement) ._ <br /> 4.5 ,A,: ' .-7 <br /> AREA TO NEAREST SQUARE FOOT: s :, ' <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: . # P ' w� <br /> 520.0 TOTAL SQUARE FOOTAGE: % ,- <br /> 2ND FLOOR: 3RD FLOOR: 520.0 � ) <br /> t <br /> ESTIMATED CONSTRUCTION COST: <br /> -+ -, 8,000.00 <br /> -p -, $ 8 000. <br /> (Please round to nearest dollar) , , ,_, ,. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑✓No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the 'property? ❑Yes ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓❑Yes Jlo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes EiNlo <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 ✓No ❑Don't know <br /> 7. Is this to correct a violation? [Yes ✓Nlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -+ <br /> 545-112(4/08) <br />