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DANECOUNTY ZONING PERMIT ZONING PERMIT NO. Page 1of2 <br /> DCPZP-2016-00636 <br /> OWNER INFORMATION AGENT/CONTRACTOR INFORMATION <br /> OWNER NAME PHONE AGENT/CONTRACTOR NAME PHONE <br /> MREC VH MADISON LLC (608)226-3100 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 6801 SOUTH TOWNE DR <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON,WI 53713 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> fgarcia @veridianhomes.com <br /> PARCEL NO. TOWNSHIP SECTION 1/4 1/4 1/4 <br /> 0708-203-4108-0 TOWN OF MIDDLETON 20 SW SW <br /> PROPERTY ADDRESS HOUSE NO. ST.DIRECTION STREET NAME ST.TYPE <br /> (Assignment of new address is 7628 English Daisy CT <br /> subject to field verification.) <br /> LOT BLOCK C.S.M.NO.or PLAT NAME <br /> 78 SPRUCE HOLLOW <br /> ZONING DISTRICT PARCEL ACREAGE PROPOSED PROJECT: New Structure/Addition CENSUS CODE <br /> A-1 Agriculture .752 Description:sfr w/porch&patio 101 -SFR(detached) <br /> District <br /> Category ® Residential ❑ Commercial fl Agricultural SEWER SANITARY PERMIT NO. <br /> 0 Other: Private 13201600292 <br /> ROAD CLASSIFICATION REZONE NO. C.U.P.NO. VARIANCE NO. DEED RESTRICTION <br /> E-All Other <br /> ❑ YES ® NO <br /> SHORELAND FLOOD ZONE WETLAND EC/SW NO. <br /> ❑ YES ® NO ❑ YES ® NO ❑ YES ® NO <br /> ____ _HEIGHT(In Feet) (BASEMENT I ist Fl tY R ITCITAM sf]IIARF FFFT s <br /> 7C <br /> cornmerce.wt.gov County <br /> Safety and Buildings Division Dane <br /> tilsconsin 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(tilled m by Co) <br /> Department of Commerce Madison,WI 53707-7162 13-2016-00292 <br /> Sanitary Permit Application State Transaction Number <br /> In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate <br /> governmental unit is required prior to obtaining a sanitary permit.Note:Application forms for state-owned Project Address(if different than mailing) <br /> POWTS are submitted to the Department of Commerce.Personal information you provide may be used for <br /> secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. <br /> I.Application Information-Please Print All Information <br /> Property Owner's Name Parcel# <br /> MREC VH MADISON LLC 0708-203-4108-0 <br /> Property Owner's Mailing Address Property Location <br /> 6801 SOUTH TOWNE DR Govt.Lot <br /> City,State Zip Code Phone Number SW i/ SW i/4 Section 20 <br /> MADISON, WI 53713 (circle one) <br /> T 07 N. R 08 E <br /> II.Type of Building(check all that apply) Lot# <br /> EI 1 or 2 Family Dwelling-Number of Bedrooms 4 78 Subdivision Name <br /> Block# SPRUCE HOLLOW <br /> ❑Public/Commercial-Describe Use CityNillage/Town of <br /> ID State Owned-Describe Use CSM Number <br /> III.Type of Permit:(Check only one box on line A.Complete line B if applicable) <br /> A. ❑New System ❑Replacement System El Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) <br /> Mound already Installed <br />