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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 /> Barbara Pauplis <br /> n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 43 Estabrook Rd.Carlisle,MA,01741 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (978)621-4870 bpauplis©gmail.com <br /> n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Carolyn Levy Tim O'Brien Homes n Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2601 Crossroads Dr.Ste.140 2601 Crossroads Dr.Ste.140 <br /> (City,State,Zip) (City,State,Zip) I-I Setbacks <br /> Madison,WI 53718 Madison,WI,53718 <br /> PHONE PHONE ❑ Site Plan approval from <br /> (608) 661-1100 (608) 661-1100 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS I�I <br /> clevy@tobhomes.com clevy@tobhomes.com I 1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 018/0711-101-2189-0 SFR-08 0.69 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> T07NR11E 10 1�4: NW 1�4: NE n Driveway permits <br /> ADDRESS: (state, county,town) <br /> TBD Wooded Ridge Trail 2177 WOODED RIDGE TRL <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑ Sanitary permits 5 BR <br /> Kennedy Hills 9 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Domain ❑ Zoning District <br /> . nThis project is a new building or structure. <br /> ❑ Permitted Use? <br /> nThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address NEW <br /> EWER 17EPTIC 13-2021-00076 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 28.6 1.0 ❑ Wetland/Floodplain/ N 9 <br /> Shoreland (attachment) <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 Control permit <br /> 2,397.0 3,417.0 ,, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance,r.,;, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 5814 X481.4 <br /> Li Review Location Survey N 0 <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ -+ '— ♦ $ 501 ,537.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes nNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? I—Yes I No nDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [LYes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes nNo <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 nNo nDon't know <br /> 7. Is this to correct a violation? nYes nNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -+ -+ <br /> REV(01/19) <br />