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ZONING PERMIT APPLICATION www.countyofdane.com <br /> . 2crt5a <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME JAMES HAHN <br /> ning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 614 GREENFIELD DEFOREST WI 53532 Restriction;CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)849-6770 amarquardt689 @gmail.com Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JEANETTE ACKER PREMIER BUILDERS INC 0 Sit- n including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of`�.*L�71IF'eptic <br /> 102 N HOLIDAY DRIVE 102 N HOLIDAY DRIVE p (l��e'�\C? <br /> (City,State,Zip) (City.State,Zip) �etbacks W£� <br /> WAUNAKEE WI 53597 WAUNAKEE WI 53597 <br /> PHONE PHONE Site Plan approval from <br /> (608) 849-6770 (608) 849-6770 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> JEANETTE.ACKER @TDS.NET JEANETTE.ACKER @TDS.NET Floor plans to scale <br /> PROPERTYILOCATION INFORMATION (http:l/accessdane.co.dane.wLusl) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAG p p y <br /> ©PARCEL 0909-102-8565-0 RH-1 ,1 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> VIENNA 10 1/4; NW 1.4+/4; NW Driveway permits <br /> ADDRESS: /,, - (state,county,town) <br /> 7(e_41 9- t20.-tk [Sanitary . <br /> CSM: !2,625 2 LOT SUBDIVISION BLOCK/LOT (p ubli private) <br /> . ) <br /> vate <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,-,f <br /> NEW HOME CONSTRUCTION A.. L1d Zoning District <br /> . FAThis project is a new building or structure. i Permitted Use? <br /> QThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: tI I Ura!Address <br /> EWER [EPTIC v--aoks- oOlup' 40 existing) <br /> HEIGHT IN FEET; NUMBER OF STORIES: (Nat including basement) <br /> 23.0 1.0 Wetland/Floodpiain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ <br /> •SionCantrol permit <br /> BASEMENT; 2,267.0 1ST FLOOR. ♦ 4, <br /> 3,920.0 t TOTAL SQUARE FOOTAGE: slopes,disturbance, <br /> G fil in. _ <br /> 2ND FLOOR: 3RD FLOOR: 6,187.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: <br /> —s --► -�• -► -► i and available options. <br /> (Please round to nearest dollar) 300,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ✓QNo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes ['No QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? JYes ['No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes EINo <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 o ©Don't know <br /> 7. Is this to correct a violation? ['yes ✓ o <br /> APPLICATION MUST BE SIGNED <br /> 15•tt2 i4. s; /\t"k\. (Continue on Back) —► —► —► <br />