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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION COST ER TO PROVIDE <br /> OWNER NAME <br /> NATURE VALLEY CONSERVANCY NEIGHBORHOOD LLC <br /> OWNER ADDRESS(Number,Street,City,State,Zip) Oning Status;CUP; <br /> /�102 N Holiday Drive,Waunakee WI 53597 Deed Restriction;CSM <br /> V/ Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)849-6770 (608)576-7240 jeanette.acker@tds.net 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Premier Builders,Inc. Premier Builders,Inc. IN Site P i uding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w tic <br /> 102 N Holiday Drive 102 N Holiday Drive <br /> V.its.ZIP) (city State,Zip) Setbacks <br /> Waunakee WI 53597 Waunakee WI 53597 <br /> Y PHONE RHONE ❑Site n a al from <br /> (608) 849-6770 608-849-6770 ap i ownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeanette.acker @tds.net jeanette.acker@tds.net PA Flo, plans to scale <br /> PROPERTYILOCATION INFORMATION (http:Itaccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: C�.ZONING: ACREAGE: FA El vati of property <br /> ©PARCEL 0909-363-6505-0 fro e drawn to scale. <br /> TOWNSHIP: + <br /> SECTION: <br /> • Vienna 36 1/: SE /1A: SW QD v ypermit- <br /> /ADDRESS: L ( e,court own <br /> 6,_ 01 6 N 4T art co v.z_ Tee i ® S_. r s permits <br /> CSM: LOT 75 SUBDIVISION BLOCK/LOT + j rivate) <br /> uAm�v.uarTau,w�eo r� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Home Construction oning District <br /> . 19 This project is a new building or structure. ermitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: A 7 -. ` •dress <br /> EWER [EPTIC 't fisting) <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) ■ <br /> ) ci :Zi-5 ° 1.0 ❑ W.,- ./F••dplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore • (a chment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Ernst• • tro e <br /> BASEMENT: 1ST FLOOR: permit <br /> 2,033.0 �r� 3 G TOTALS4UAREFOOrACE: (slop== st...LLance, <br /> 0. � flr. - <br /> 2ND FLOOR: 3RD FLOOR: k5$7, <br /> �� � / - 0 Review Location Survey <br /> ESTIMATE NSTRUCTION COST: �/ <br /> (Please nd to nearest dollar) • -► —► —► —► —► $ 400,000.00 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes [)lo QDon't know ) ,.....s 2. Is there a wetland or floodplain on or near the property? Q Yes o ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes Jo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes 1 }o <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 ONo DDon't know <br /> 7. Is this to correct a violation? OYes ✓[ No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(, (Continue on Back) --o.--o. --P.--P. -0. <br /> sa ) <br />