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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME DENNIS MIDTHUN-Capital Investments <br /> ER ADDRESS (Number,Street,City,State,Zip) <br /> 0 Oning Status; CUP;; <br /> 13845 W BOLLARD RD EVANSVIL o WI 53536 Deed Restriction; CSM <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS Variance(# ) <br /> (608)444-4797 JEANETTE.ACKER @TDS.NET ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JEANETTE ACKER Premier Builders Inc. an 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) backs <br /> \ Waunakee WI 53597 Waunakee WI 53597 <br /> PHONE PHONE ❑Site P -• -_• oval from <br /> (608) 849-6770 (608) 849-6770 ap• •--ale •wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeanette.acker @tds.net jeanette.acker @tds.ent oor lans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUMBER: C} RENT;CITING: ACREAGE: P P y <br /> lig PARCEL 0811-123-4177-0 p�—1 Gi , .6' fro ge drawn to scale. <br /> NUMBER ' <br /> TOWNSHIP: SECTION: <br /> Sun Prairie 12 +/4: sw 1/414: sw Driveway perm <br /> •VADDRsS„ES (state nty,town <br /> o`'� �,r anitary pe •• is <br /> CSM: Lcrcco,,10,y4 SUBDIVISION BLOCK/LOT (publi <br /> / Savannah Valley ► • <br /> ► <br /> PROPOSED PROJECT INFORMATION STAFF ),l', <br /> PROJECT DESCRIPTION: <br /> New Home Construction A W/ (12 /!40MN)District <br /> . 151This project is a new building or structure. nnte400 <br /> This project is an addition/alteration to an existing building or structure. ' <br /> SANITARY SERVICE: PER ON'NUMBER: r,4; I Ness <br /> EWER [EPTIC f S-3 )) 0(\ c>1 ( r ruing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including bAsement) <br /> 29.0 2.0 i- • ••', ,in/ <br /> ® : . , • °t r_ hment) <br /> AREA TO NEAREST SQUARE FOOT <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) 7 ii <br /> BASEMENT 1ST FLOOR: E{; �D@t�r• permit <br /> 1,796.0 3,106.0 + TOTAL SQUARE FOOTAGE: 4, a•" ' , •=fCe, <br /> 4 J1'O. t,_? <br /> 2ND FLOOR: 3RD FLOOR: <br /> 750.0 5,652.0 . CI irk*: • . . ,,,urvey' <br /> ESTIMATED CONSTRUCTION COST: and t, , : ,,'ons, <br /> (Please round to nearest dollar) -r '♦ -r 'r ♦ -* $ 290,000.00 <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑Do t knoS <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? o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es P415-- <br /> 5. Is this project associated witha rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [Yes ❑INo n't know <br /> 7. Is this to correct a violation? ['Yes jple- <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —r <br /> 545-112(4/08) <br />