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commerce.wi.gov -County <br /> Safety and Buildings Division Dane <br /> I scO il S I fl 201 W.Washington Ave.,P.O.Box 7162 <br /> Madison,WI 53707-7162 Sanitary Permit Number(filled in by Co) <br /> Department of Commerce 13-2017-00070 <br /> State Transaction Number <br /> Sanitary Permit Application <br /> In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate <br /> governmental unit is required prior to obtaining a sanitary permit.Note:Application forms for state-owned Project Address(if different than mailing) <br /> POWTS are submitted to the Department of Commerce.Personal information you provide may be used for <br /> secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. <br /> I.Application Information-Please Print All Information <br /> Property Owner's Name Parcel <br /> DONALD C TIERNE.Y _ 091 1-303-4012-0 <br /> t .7 <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyclane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Pete and Tara Klun ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> PO Box 213, Cottage Grove Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)279-6012 pete.klun @uscellular.com ❑Site PI. -� • scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and in. M,I men-ions • <br /> AGENT NAME CONTRACTOR NAME <br /> Flat Fee Home Builders/Tony Magestro ❑Site Play ir1luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s is <br /> PO Box 213 � <br /> r <br /> (City,State,Zip) (City,State,Zip) ❑Selpas&s . C <br /> Cottage Grove, Wi 53527 �v/ J <br /> PHONE PHONE ❑Site PI 5 a oval from <br /> (608) 225-7311 applicalENhip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tony @flatfeebuild.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT P M�^ t�n CURRENT ZONING: ACREAGE: ❑Elevatio property <br /> IDPARCEL O' 7 IOIL_o R1 0.80 frontage rawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Sun Prairie 1/: 1/1/: El Drivew its <br /> ADDRESS: 3L97 L �W"V -I / n (state, `Y <br /> CSM: OT J SUB✓`DIVISION!![ ► f BLOCK/LOT ❑San . . •�' Ai,- <br /> 22 (pub lc •rjr v r <br /> Bristol Gardens <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> new contruction/single family 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:13,201,700,070 ❑ Rural Address <br /> EWER EPTIC (new/existing) <br /> HEIGH F E • I NUMBER OF STORIES: (Not including basement) <br /> 22.0 �� 1.0 1,a n a <br /> J v O ea '': :a ( f: r ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: Erosion , 0, • nn <br /> 2,290.0 2,600.0 ,, TOTAL SQUARE FOOTAGE: 4, (sic*. ,4 ,.., ' -, <br /> fitting/: . a,z‘_ <br /> 2ND FLOOR: 3RD FLOOR: IASCi® <br /> ESTIMATED CONSTRUCTION COST: Q� ORS t ,4- u ey <br /> (Please round to nearest dollar) ♦ ♦ ♦ -* -► -+ $ 450,000.00 and a 0•c�sl ... <br />