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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 /> Brian Miller LaZoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restriction;CSM <br /> 500 106th Ave NE#703 BELLEVUE WA 98004 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)849-6770 miller brianj,@msn.com Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> JEANETTE ACKER PREMIER BUILDERS INC. ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS • of w II/septic <br /> 102 N HOLIDAY DRIVE 102 N HOLIDAY DRIVE <br /> (City.State,Zip) (City.State.Zip) Setbacks <br /> WAUNAKEE WI 53597 WAUNAKEE WI 53597 <br /> PHONE PHONE Site Plan approval from)"/t �_ <br /> (608) 849-6770 (608) 849-6770 applicable township. <br /> E-MAILADORESS E-MAIL ADDRESS <br /> JEANETTEACEKR@GMAIL.COM JEANETTEACKERQGMAIL.COM 'or plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) I @Va <br /> PARENT PARCEL NUMBER: CURRENT Z NING: ACREAGE: tion of property <br /> WA N PARCEL UMBER 0708-321-4222-0 A _ I © , 7G S frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> • MIDDLETON 32 +/a; +/a+/a: � liveway permits j.. <br /> ADDRESS: <br /> (state,county,town) <br /> 7 ? L OV 4ctA P .S S anitary permits <br /> CSM: LoT SUBDIVISION BLOCK/LOT <br /> 12 (public,private) <br /> ASPEN MEADOWS 6 S 1 c,--e S <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION: I <br /> NEW HOME CONSTRUCTION 0.�A L c x aCo 'Poo( OZoning District <br /> o 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: O..i'(r Address <br /> FEWER 7EPTIC \3 -- ao [7 -^ 1 sting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not Including basement) <br /> 26.0 l(e1 M2ar\ 1.0 etland/Floodplain/ I•-“ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages`d above grade decks or porches) rosionCOntrol permit�Q <br /> BASEMENT. 1ST FLOOR: /- <br /> 2,573.0 4,066.1 4-J , 14, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: r( filling/access) <br /> C4 60) 6,639.0 `0'Rview Location Survey y=5 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 490,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓❑Pro DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes �Io ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes lalo <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) ors ❑No on't know <br /> 7. Is this to correct a violation? ❑Yes Oro <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545412(vos) <br />