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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME MATT PLUMMER <br /> Ing Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 2618 PROGRESS RD MADISON WI 53716 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)212-3379 PLUMMER @QUALITY-ONE-ELECTRIC.COM 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> OWNER OWNER <br /> 151 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) el Setbacks <br /> PHONE PHONE ❑Site Ian proval from <br /> applic township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ' <br /> 0 Floor plan to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: isi <br /> ❑PARCEL 012/0911-304-4047-0 • Al 5.54 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> BRISTOL ID Irk 1/4: SE 1/41/4: Sao,19.11 ❑Driv ay permits <br /> ADDRESS:, �� / � 1 1 (state, u wn) <br /> CSM: �� LOT v i SUBDIVISION BLOCK/LOT Sanitary pe mits Bp......, l 57 BROOKS ESTATES (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> AFF REVIEW <br /> PROJECT DESCRIPTION: i_d, <br /> NEW SINGLE FAMILY HOME zoning District <br /> . MI This project is a new building or structure. ' <br /> tructure. rmitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ R ral Address <br /> EWER [EPTIC 1 1) c °0( -0e\a.(0 ( xisting) <br /> HEIGHT IN NUMBER OF STORIES: (Not including basement) \�JJ <br /> 2.0 ❑ W, .•d/Floodplain/ <br /> S orela • -ttachme t) CI <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ Erosi• of permit <br /> BASEMENT: <br /> 1 ,811 .0 1ST FLOOR: 2,921 .0 <br /> I TOTAL SQUARE FOOTAGE: ,,, (SIO•,' , •'sturbance, i0 <br /> ♦ filling/acc-ss) <br /> 2ND FLOOR:2,696.0 3RD FLOOR 7,428.0 <br /> ❑ Review Loc • urvey� <br /> ESTIMATED CONSTRUCTION COST: and av •• le tions. <br /> (Please round to nearest dollar) ♦ ♦ -P ♦ ♦ ♦ $ 500,000.00 P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes Elo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes 'lo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes Llo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes a <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) Dies a0 ❑Don't know <br /> 7. Is this to correct a violation? Dies 'lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112 14/08) (Continue on Back) ■ ■ -+ <br />