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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME M Hebert <br /> Matthew V' oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 3234 Saracen Way Verona WI 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)215-3261 sherri.hebert14 @gmail.com plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Recreational Concepts Inc Recreational Concepts Inc Site a luding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS w septic <br /> 121 N Main St 121 N Main St <br /> (City,State,Zip) (City,State,Zip) acks <br /> Oregon WI 53575 Oregon WI 53575 <br /> PHONE PHONE ❑Site approval from <br /> (608) 835-2780 (608) 835-2780 cab township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> recconinc @ymail.com recconinc @ymail.com n - oo • - to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elev- of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 03/0708-323-6100-0 414 A-, 0.75 f • ag: drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Middleton 1/4: 1/41/4. p Drive - permits <br /> (s - -, aunty,town) <br /> ADDRESS: 3234 Saracen Way Verona WI 53593 <br /> CSM: LOT SUBDIVISION BLOCK/LOT El(p •' permits <br /> 0 (p % ic, rivate) <br /> Glaciers Woods <br /> PROPOSED PROJECT INFORMATION ST REVIEW <br /> PROJECT DESCRIPTION: <br /> 16'x 35' in ground swimming pool onin!_=istrict <br /> t This project is a new building or structure. Ili rmitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMITpBE7 ❑ Rura - <br /> [)EWER . EPTIC ( : I <br /> HEIGHT IN FEET: xl NUMBER OF i ES: (Not including basement) <br /> ❑ Wedan. oodplain/ <br /> ; <br /> AREA TO NEAREST SQUAR FOOT: ore a "` atta ent) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 1ST FLOOR: OSiOnCOntfOl penYllt M <br /> , TOTAL SQUARE FOOTAGE: (slopes,disturbance, jc�40 O <br /> filli access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 6 tA eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ M and available ons. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ --► $ t C) (�(�a <br /> / I {n <br /> ��Y/N <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ao <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 ❑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 />