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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Don Tierney [j Zoning Status;CUP; <br /> OWNER ADDRESS (Number.Street.City.State,Zip) Deed Restriction;CSM <br /> 3564 Egre Rd Deforest WI 53532 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)241-0102 Jktiemey©1791.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jeanette Acker Premier Builders Inc. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 102 N HOliday Drive 102 N Hoiday Drive <br /> (City.State.Zip) (City.State,Zip) ❑Setbacks <br /> Waunakee WI 53597 Waunakee,WI 53597 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 849-6770 (608) 849-6770 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeanette.acker @tds.net jeanette.acker©tds.net ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> pi PARCEL 0911-303-4200-0 1 , , 441 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Bristol 30 IA; SW �4%/4. sw El Driveway permits <br /> ADDRESS: (state,county,town) <br /> ,31 1 $ L ' t 4'-tS R V A—I <br /> CSM: LOT 80 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> Bristol Gardens (public,private) <br /> PROPOSED PROJECT INFORMATION ' y -i ?j ..4-14 <br /> PROJECT DESCRIPTION: ,' <br /> New Home Construction 'LI W ;t a ,i'i <br /> • Fl This project is a new building or structure. ' „ , k <br /> Ii t4 <br /> ['This project is an addition/alteration to an existing building or structure. i� <br /> SANITARY SERVICE PERMIT NUMBER: '',�.yT.G---;7 t �---- : <br /> EWER [EPTIC y4 i i t'� s� 1 i. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) ,- " Y.', : �� <br /> 26.0 1.0 ` rn> rf ,`�,, �, ,,�—,t,� <br /> AREA TO NEAREST SQUARE FOOT: 1—l' ''t n a ti) <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) ' <br /> a t(,fe 9L1. t <br /> BASEMENT 1ST FLOOR: + r i } <br /> TOTAL SQUARE FOOTAGE °'' 'iii ir,: 9z <br /> 2,294.0 3,770.0 .;-: r <br /> 2ND FLOOR: 3RD FLOOR: , :�,�,� � , , <br /> 6,064.0 .'�. <br /> ESTIMATED CONSTRUCTION COST: .4. -4► .; , +I :;!!_ Ii y .i� <br /> (Please round to nearest dollar) 'P 459,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓N° ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes alo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes I No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes ✓No <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 [al. ✓❑Don't know <br /> 7. Is this to correct a violation? [Yes ato <br /> APPLICATION MUST BE SIGNED <br /> 545.112 ter (Continue on Back) -, —► <br />