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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CU OMER TO PROVIDE <br /> OWNER NAME , <br /> , ,2 ` e^,99,—, Zo ng Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) D ed Restriction;CSM <br /> { - O/ g 2-e. .,Pe_Y,7" 6-Y riance(# ) <br /> HOME PHONE CELL PHONE V E-MAIL ADDRESS <br /> Cam(- f- 3 / 6 ; (608)849-6770 jeanette.acker @tds.net S'a Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION d includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeanette Acker Premier Builders Inc S. Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS well/septic <br /> 102 N Holiday Drive 102 N Holiday Drive <br /> (City,State,Zip) (City,State.Zip) Setbacks <br /> Waunakee WI 5359 Waunakee WI 53597 <br /> PHONE •PHONE ❑S. a PlarlArproval from <br /> (608) 849-6770 (608) 849-6770 p township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> jeanette.acker @tds.net jeanette.acker @tds.net loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wLus/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p rty <br /> © PARCEL 0911-303-0513-0 A-1 0.76 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Bristol 30 1/: NE 'WA: SW ❑Driveway permits F ADDRESS J 0 / r lL� � p estate,county,town) <br /> n / )) t V1.-. ' <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> Bristol Gardens 63 <br /> (! blic,private) <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DES R}PTION: / D <br /> A/' .) 0,7c )96 G f1ni'lt' ''c- / Ike oning District <br /> . <br /> This project is a new building or structure. -C 1Z (�'« <br /> ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: = ra •ddress <br /> HEWER [EPTIC I �a a,s (�Q (new/'xisttng) <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) <br /> 31.0 2.0 Li Wetlan oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Silo and (attachment) <br /> (Outside dime In ding unfinished area,atta •-: •- -:•s and above grade decks or porches) <br /> BASEMEN 1STFLOQ� ❑ ErosionCo permit <br /> 2,198.0 i,771.0 4„ TOTAL SQUARE FOOTAGE: I (slopes Sturbance, <br /> 2ND FLOs: - -'FLOG <br /> `—�—\ fillin ccess) <br /> , •. ,'�l ", C7,195.0 Q Review Location Survey <br /> ESTIMA • . -U <br /> ( ) -°' -► --s' -- -•' -4- $ 460,000.00 and available options. <br /> Please round to nearest dollar <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Lives Q✓No QDon`t know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes [lio QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q <br /> QYes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0Y ✓7lo <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) JYes E1No n't know <br /> 7. Is this to correct a violation? Dyes EINo <br /> ,S APPLICATION MUST BE SIGNED <br /> SA545-112{4108} ,41,_.c. 9 (Continue on Back) -. -0, -+ <br />