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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> / <br /> PROPERTY OWNER INFORMATION CU$ OMER TO PROVIDE <br /> OWNER NAME - <br /> Dennis Midthun ©Zoning Status; CUP; M /1\ — I <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CS <br /> 13845 W Bullard Rd,Evansville WI 53536 Variance(# ) <br /> HOME PHONE CELL PH•NE E-MAIL ADDRESS <br /> / Tl7 IA ' 4244 •• G�ihE ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION end includes dimensions <br /> AGENT NAME CONTRACTOR NAME / / <br /> Jeanette Acker Premier Builders,Inc. <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 102 N Holiday Drive 102 N Holiday Drive <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <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 /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENTli9NING; ACREAGE: \ Q Elevation of property <br /> WA PACER 0607-234-9720-0 f- /t frontage drawn to scale. <br /> TOWNSHIP: SE ON: / <br /> Springdale y___ IA: _5. '/4'/4:�� ❑D iveway permits L <br /> e county,tow• <br /> ADDRESS: C Q LT Ce) 'n 1 �/ Sanity ermits F' �1ti1 ry p csM. 10,595 - 2 SUBDIVISIO BLOCK/LOT (pu. 'c,private) t /` <br /> PROPOSED PROJECT INFORMATION ! ..s4 <br /> PROJECT DESCRIPTION: / <br /> new home construction 'vy u'1L 6' , c k-S7 ning,b.(strict • i it <br /> This project is a new building or structure. <br /> 3 t c,, S <br /> errrtittedVse?.' <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: .= ''e o :' '.'' <br /> EWER 17TEPTIC 13,201,500,381 = > i rig) <br /> HEIGHT IN FEET: a 7 NUMBER OF STORIES: (NGt• eluding basement) <br /> ❑ Wetland/Flpoti ai <br /> . Shore and (attachment) <br /> AREA TO NEAREST SQUARE FOOT: k <br /> (Outsi.a_dirnsions including unfinished area,attached garages and above grade decks or porches) ' <br /> ErosionGontnol ' <br /> BA- ENT: - /••E40��l. 4 TOTAL SQUARE FOOTAGE: 4 (slopes,dl ' Dance, <br /> 1 l,' 9 fk6"`�'' (.3 l ( -7-r�?"'-19` • Review Location Sury c <br /> STIMATE S 'ONSTRUCTION COST: available options. <br /> (• :. _ .und to nearest dollar) -41. .+ -0. -� -0. -P. 400,000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes o 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? 2re o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes [ Dk <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 No .43.:•'t know <br /> 7. Is this to correct a violation? [Yes E NG- <br /> 3 <br /> .14 ^s 01: - ,;,,`7, APPLICATION MUST BE SIGNED <br /> 3 - (Continue on Back) -d► -► -► <br /> 545.112(4/GB) <br />