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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Robert Hostrawser <br /> oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 1174 Nira lane Edgerton,Wl 53534 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)213-1807 robhostrawser @gmail.com E Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR A RESS of well/septic <br /> / (City,State,Zip) _..3 (City,State,Zip) �,$'et� <br /> \// PHONE PHONE ['Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [door plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 3-Elevation of property <br /> ❑NUMBER 0512-054-5699-0 R-1 2-3 ,3 0.50 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Town of Albion 5 1/4. sw 1/41/4. SE arfriveway permits <br /> ADDRESS: (state,county,town) <br /> 11.--4. Nira Lane permits <br /> CSM: LOT 19 SUBDIVISION BLOCK/LOT (public,private) 3 <br /> Blue Meadow Estates <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: C\\ <br /> SFR,With front and rear patio ci Zoning District <br /> . 12 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: MG Address <br /> JEWER [EPTIC /3-don- :ENV / C ,tra9 s <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ❑�*•�•� <br /> i6, 1.0 t4I •,t'plain/ <br /> AREA TO NEAREST SQUARE FOOT <br /> Shor- attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) flint <br /> BASEMENT 1ST FLOOR: ❑ Ef+- + es i • pe <br /> 1,991.0 3,234.0 ,, TOTAL SQUARE FOOTAGE: + (Sl••=- +I •s nce, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 5,225.0 � � <br /> 1Cf R= ' ey <br /> ESTIMATED CONSTRUCTION COST: and available • ,, <br /> •ij0, <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 ✓DVo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes no �on't know <br /> ❑ <br /> 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? ❑Yes Olo <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 DiVo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes EIVo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► ■ -► <br />