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ZC MING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> mark watts <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status;CUP; <br /> 3577 pioneer rd,verona,wi,53593 Deed Restriction;CSM <br /> HOME PHONE CELL PHONE ariance(# ) <br /> E-MAIL E-MAILADDRESS <br /> (608)849-6770 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> kyle acker premier builders D Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 102 north holiday 102 north holiday <br /> (City,State,Zip) (City,State,Zip) D Setbacks <br /> waunakee,wi,53597 waunakee,wi,53597 <br /> PHONE PHONE D Site Plan approval from <br /> (608) 576-7214 (608) 576-7214 applicable township. <br /> E-MAILADDRESS E-MAILADDRESS <br /> kyleacker.premier@gmail.com jeanette.acker @tds.net ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> pg 0 PARCEL 0708-293-9015-2 <br /> NUMBER A- 1 S.1'V 3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> middleton 29 %/4, sw 1/444, sw [Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 7,849 1 (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> new home construction ❑ Zoning District _ <br /> 0 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 [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 24.0 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 2,523.0 3875,0 j TOTAL SQUARE FOOTAGE: ,', (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 6,398.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 372,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes I No DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYeslo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes jNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ✓ZVo <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 alo r4Don't know <br /> 7. Is this to correct a violation? [Yes IDNo <br /> APPLICATION MUST BE SIGNED <br /> yu t12( ) (Continue on Back) —s —I. —s <br />