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� ( 1 <br /> SUPPLEMENT to Web-App it <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Steven & Ann Robertson Bonin Status;CUP <br /> OWNER ADDRESS (Number,Street,City,State.Zip) P,Oef eStriCtIOn;CSM <br /> S it <br /> 1722 Hidden Hill Dr,Verona,WI 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)239-3635 sj_robertson @yahoo.com;arobertson1960 @gmail.com ❑Site Plan drawn to sca <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dime <br /> AGENT NAME CONTRACTOR NAME <br /> Justin Temple Temple Builders LLC ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2501 W Beltline Hwy,Suite 113 2501 W Beltline Hwy,Suite 113 <br /> (City,State.Zip) (City State.Zip) ❑Setbacks <br /> Madison,WI 53713 Madison,WI 53713 <br /> PHONE PHONE ❑Site PI: , :. • from <br /> (608) 729-3990 (608) 729-3990 applic%.let.wns ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jtemple @templebuilds.com jtemple @templebuilds.com ❑ Floor plan o scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wl.us/) ❑Elevatior,o roperty <br /> PARENT PARCEL NUMBER. CURRENT ZONING ACREAGE T, - <br /> ❑PARCEL 062/0608-052-2531-0 �_y 89,910.00 frontage awn to scale. <br /> NUMBER <br /> TOWNSHIP SECTION <br /> Verona 5 �/; 6N %/4�/a; 06 E/W EIPOVOWaY permits <br /> ADDRESS (state,county, town) <br /> Unit 11, Woodhill Circle 3(cl-7 t,,,oQp t-1144_. c:.(2- <br /> CSM LOT 1 1 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> Woods at Watch Hill (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION. <br /> SAC ❑ Zoning 6ttict <br /> 4 This project is a new building or structure. ❑ Permitt vise? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER <br /> EWER JEPTIC i 13,201,700,033 (new/existing) <br /> HEIGHT IN FEET \A9IUMBER OF STORIES (Not including basement) <br /> 22.0 HO\ 1.o ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages nd above grade decks or porches) <br /> BASEMENT/ 1ST FLOOR � 4,` ❑ ErosionControl permit <br /> V2,503.0 nu�� 3,717.0 TOTAL SQUARE FOOTAGE: 4, (slopes,da ididirnittept" <br /> 2ND FLOOR 3RD FLOOR: filling/access) <br /> 0.0 0.0 6,220.0 ❑ Revie o ey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ ♦ ♦ Q and a it 1 op'ons. <br /> $ <br /> (Please round to nearest dollar) 61 0,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ONo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Ekes rNo <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 ININo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes 151 No <br /> APPLICATION MUST BE SIGNED <br /> 545-112 4/08) <br /> (Continue on Back) -* -+ -+( <br />