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+1q# 63 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Don Tierney <br /> OWNER ADDRESS (Number,Street,City,State.Zip) ❑Zoning Stat <br /> 3564 Egre Rd Deforest WI 53532 Deed Restric n; CSM <br /> HOME PHONE CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> (608)241-0102 jktierney @fronter.com ❑Site Plan drawn Cale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and include ensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeanette Acker Premier Builders,Inc. ❑Site Plan Incl • g location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/se f• <br /> 102 N Holiday Drive 102 N Holiday Drive <br /> (City,State,Zip) (City,State,Zip) ❑Setb C S <br /> Waunakee WI 53597 Waunakee WI 53597 <br /> PHONE PHONE ❑Site Plan •,r;•-1 from <br /> E-MAIL ADDRESS (608) 849-6770 E-MAIL ADDRESS (608) 849-6770 applica. t. , ., <br /> jeanette.acker @tds.net jeanette.acker @tds.net ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT.n ING: ACREA ❑Elevatio Of perty <br /> IN PARCEL NUMBER 0911-303-0371-0 � �� frontage r n to scale. <br /> TOWNSHIP: SECTION: <br /> Bristol 30 /4: NE %aIA: SW ❑Drive a +�� its <br /> ADDRESS: 30^ �/ i a (Stat- own) <br /> !j I L ,. r <br /> Y <br /> CSM LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 11 Bristol Gardens (public,private) ir-vv\ <br /> PROPOSED PROJECT INFORMATION ' 7 a, 3 t <br /> PROJECT DESCRIPTION: % /� � <br /> New Home Construction .;i 0,. ,, i - <br /> 4 This project is a new building or structure. ;/ ? / , <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE PERMIT NUMBER: 4 � <br /> EWER 174EPTIC •.21 1! 002 '7 ( r e; s!, <br /> HEIGHT IN FEET NUMBER O.—STORIES: (Not including basement) <br /> 1122.0 ° 3 � � /., ,/ <br /> AREA TO NEAREST SQUARE FOOT: ; j t <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: % =+ae , + ',43a •$ <br /> 2,224.0 3,503,0 1 TOTAL SQUARE FOOTAGE: 4, " *a:W e .:•r r/-a <br /> 2ND FLOOR: s,�i ,�§ <br /> 3RD <br /> 5,727.0 <br /> ESTIMATED CONSTRUCTION COST: q ,% <br /> --I. $ 2/ <9D o . a s <br /> (Please round to nearest dollar) �C./�'V......._ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes �No ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ■ • ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? taes •No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes go <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) g'es ENo ❑Don't know <br /> 7. Is this to correct a violation? [Yes gtlo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -r -r -, <br />