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II <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Dennis Midthun ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.Cary,State,Zip) Deed Restriction;CSM <br /> 3518 Sabaka Trail Verona WI 53593 Variance(# ) <br /> HOME PHONE CELL PHONE 1E-MAIL ADDRESS <br /> (608)849-6770 midthun @hotmail.com © 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. <br /> 1-71 1 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 102 N Holiday Drive 102 N Holiday Drive <br /> (City,State,Zip) (City,State,Zip) Q Setbacks <br /> Waunakee WI 53597 Waunakee WI 53597 <br /> PHONE PHON C 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 C Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpl/accessdane.co.dane.wLusl) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: © Elevation of property <br /> ©PARCEL 0607-254-8540-0 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: I�I <br /> Verona 25 i/: SE 1/41/: NE t I Driveway permits <br /> ADDRESS: • <br /> (state,county,town) <br /> I/ e--r T e) ---c - © Sanitary permits <br /> CSM: LOT t BLOCK/LOT <br /> 1 2,742 <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Home Construction Li Zoning District <br /> . Q This project is a new building or structure. L_1 Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Li Rural Address <br /> [EWER {EPTIC 13,201 ,700,032 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 33.0 2.0 ❑ 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 /> ErosionControl permit <br /> BASEMENT: 1ST FLOOR: ' TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 1 194.0 3 020.0 j filling/access) <br /> 2ND FLOOR: 1 ,226.0 3RD FLOOR: 4,246.0 <br /> Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options, <br /> (Please round to nearest dollar) -* -'. -; -. ♦ -s $ 410,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No nDon't know <br /> 2. Is there a wetland or floodplain on or near the property? n✓ Yes Ohio ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes F4No <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) nYes ❑No CDon't know <br /> 7. Is this to correct a violation? [—Yes QNo <br /> Cam( Z�� /1—'-'00.51 APPLICATION MUST BE SIGNED <br /> 545.112 tar.1 D (Continue on Back) --► —s —s <br />