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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> _ PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Steve & Elaine Hathaway Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 9254 Bear Claw Way, Madison, WI 53717 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-831-9188 ` Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION :nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Michael F. Simon Builders, Inc. Michael F. Simon Builders, Inc. Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 817 South Division Street 817 South Division Street <br /> f k (City,State,Zip) (City,State,Zip) Setbacks <br /> /� Waunakee, WI 53597 Waunakee, WI 53597 <br /> PHONE PHONE - i�.Site Plan approval from <br /> 608-849-5916 608-849-5916 pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> fRbuilder @simonbuilds.com builder @simonbuilds.com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURR ZONI G: ACREAGE: P P y <br /> ❑ PARCEL 038/0708-192-8025-0 3.5157 rontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECT O �i <br /> Middleton 1/4: 1 v 1/41/4: Driveway per:- <br /> ADDRESS: (state,court town <br /> 7799 Old Sauk Road, Middleton, WI 53562 <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanita its <br /> (public <br /> 11083 3 ld Sauk Estates <br /> PROPOSED PROJECT INFORMATION STAFF,REVIIIEW <br /> PROJECT DESCRIPTION: <br /> New home construction . Zoning District <br /> . 3 This project is a new building or structure. ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Ural Adtlres <br /> ❑SEWER ■ $EPTIC 518071 1 (new/existing <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 23' V I 1 S tt i d/FI otlpIainl. <br /> AREA TO NEAREST SQUARE FOOT: �Ielartrl (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: � � 8 ® <br /> 2,175 3,8 2(] + TOTAL SQUARE FOOTAGE: + .pes,disturban�'-, �. <br /> vl� . ,#+W,_ <br /> 2ND FLOOR: 3RD FLOOR: <br /> 5,995 )(Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available,o tions. <br /> (Please round to nearest dollar) ..+ ♦ ..+ ,.+ ♦ ♦ 4) 750,000.00 P <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes Giii,No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes , 'JO ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? (Sa• es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? LI Yes clo <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 ,d4No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Xlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ —► <br /> 545-112(4/08) <br />