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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> 4\C_ C) <br /> PROPERTY OWNER INFORMATION CU TOMER T PROVIDE <br /> OWNER NAME PREMIER BUILDERS, INC <br /> Zonpg Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,state.Zip) Dped Restriction;CSM <br /> 102 N HOLIDAY DRIVE WAUNAKEE WI 53597 dance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS / <br /> (608)576-7240 JEANETTEACKER@TDS.NET ®Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JEANETTEACKERc@TDS.NET PREMIER BUILDERS INC. U Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 102 N HOLIDAY DR 102 N HOUDAY DRIVE <br /> (City,State,Zip) (City,State.Zip) ❑Setbacks <br /> WAUNAKEE WI 53597 WAUNAKEE WI 53597 <br /> ❑Site`Pla .e'p <br /> PHONE PHONE proval from <br /> (608) 8 A 9_6770 (608) 849-6770 a i#a le township. <br /> E-MAIL ADDRESS C7 �F E-MAIL ADDRESS / ` <br /> JEANETTEAC ®T <br /> KERQTDS.NET JEANETTE.ACKERDS.NET ['Floor plans to scale <br /> PROPERTYiLOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CUR NTZO NG: ACREAG • EfElevation of property <br /> IN PARCEL 0711-332-8800-0 – fro age drawn to scalp. - <br /> NUMBER + <br /> TOWNSHIP: SECTION: <br /> COTTAGE GROVE %: NW '/41/4: NW Driveway permits I <br /> fate,county,town) i T-0 0 ADDRESS: 3.....=c6;2. Fie_g17 I e v„) L o`y/e Sanitary permits <br /> WI A Y1 <br /> CSM: 11,964 LOT 2 SUBDIVISION BLOCK/LOT (public,private) k d f w S <br /> _ q- <br /> PROPOSED PROJECT INFORMATION AFF+. IEW IN n <br /> PROJECT DESCRIPTION: l / ' n <br /> NEW HOME CONSTRUCTION \j<) 0 .v t f' 4 & 0 Q ./\,'� —I 9.D strict +�( V1 <br /> / _ <br /> • a This project is a new building or structure. 1iBrmiftêdUse? �: <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT UMBER / /� ` �' i Rural Address <br /> EWER [EPTIC l ~ f ) - (J01 7 0 r(new/exlsting). <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) '� ,. <br /> a -26 0- 2.0vveilendjFloodplain/ <br /> Slorela (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: 4713g7-:(3--0)/ 0 'EroswnControlpermit <br /> 1,082.0 4, TOTAL SQUARE FOOTAGE: 4, (sl9pes,disturbance, <br /> 2ND FLOOR: ((}}¢�p�� 3RD FLOOR: / r fll�i�1g/aCC@SS) / <br /> ` $$f&/V -T� '0'' <br /> GI/Review Location Survey CS <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ -► -•► _� ♦ and available options. <br /> (Please round to nearest dollar) $ 270,000.00 <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 LNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ONo <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) Ekes ONo IN Don't know <br /> 7. Is this to correct a violation? [Yes OW <br /> 1 APPLICATION MUST BE SIGNED <br /> 545.112(4108) V Q (Continue on Back) —► —► —► <br />