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t.--(-- . p.....e, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION GUSTO R TO PROVIDE <br /> OWNER NAME <br /> Springfield Ridge Developement Group K I 114 <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 6198 Amethyst Drive Waunakee WI 53597 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> ❑Site PI d n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inc es dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeanette Acker Premier Builders,Inc. ❑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) ❑Setbacks LO e <br /> Waunakee WI 53597 Waunakee WI 53597 �. <br /> PHONE PHONE ❑Site PI •A∎val from <br /> (608) 849-6770 (608) 849-6770 applic •. <br /> E-MAIL ADDR ESS 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/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURREN 0 ARREA E: <br /> W PARCEL 0808-043-4145-0 /�— e ( frontage drawn to scale. <br /> NUMBER 666 <br /> TOWNSHIP: SECTIO <br /> • Springfield 4 1/4; NE 1�41�,; SW ❑Drive y pe Its <br /> ADDRESS: c (state, ty,town) t <br /> � ' A-rn„efi� J� Dr • ❑Sanitary permits �� <br /> CSM: LOT SUBDMSION BLOCK/LOT re& n <br /> 5 Springfield Ridge (public,private) CA) <br /> ; <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: _2 <br /> }�i/.... ❑ Zoning ist <br /> . 151This project is a new building or structure. ❑ Perm d Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE:kEWER EPTIC PERMIT N1 M$FR:....2_614 , 6 0 J / G ❑ ilL l. Sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) 1 - <br /> 23.0 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 2,086.0/ 3,371.0 j filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 5,457.0 ❑ Rev' Lo f Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► -► -► and ins. <br /> (Please round to nearest dollar) $ 363,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓aIo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes JNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 01/es ✓No <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).... le S ❑Yes ❑No Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> 545-112(4/08) <br />