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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App 0 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Cristy Lee ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State.Zip) Deed Restriction;CSM <br /> 4549 Deering Trail,Middleton,WI 53562 Variance(# ) <br /> HOME PHONE i CELL PHONE E-MAIL ADDRESS <br /> (608)213-9010 cristyslee @outlook.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Justin Temple Temple Builders LLC ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2501 W Beltline Hwy,Suite 113 2501 W Beltline Hwy,Suite 113 <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Madison,WI 53713 Madison,WI 53713 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 729-3990 (608) 729-3990 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jtemple @templebuilds.com jtemple @templebuilds.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpi/accessdane.co.dano.wl.us/) I=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURREINTZO ING ACREAGE <br /> 1:1 NUMBER 19 q0T08'-32314/00-0 F;^ . 1(90 frontage drawn to scale. <br /> TOWNSHIP: SECTION <br /> Middleton 3Z /,: 6 W '%'%: 5e ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> gt/8got 10 Felton Dr <br /> ❑Sanitary permits <br /> CSM: LOT 10 SUBDIVISION BLOCK/LOT (public,private) <br /> Meadow Road Estates <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residence ❑ Zoning District <br /> . IN This project is a new building or structure. ❑ Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER MEPTIC IS'.Zt 1?.+ 0O O 4( (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> Z f, 1 ❑ 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 /> BASEMENT 1ST FLOOR <br /> ❑ ErosionControl permit <br /> Z , <br /> v V 40 0 0 , TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR 3RD FLOOR: c Q filling/access). <br /> �7 7O <br /> ❑ Review Location-Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ b�� COQ and available options. <br /> (Please round to nearest dollar) 1 > <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes 'lo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes to ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ws No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes Igo <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) laces ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -i -► <br /> 545-112(4/08) <br />