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'l iL , ?-0,1,1 . <br /> 4-<-K. S i&---c ( 14' 10 SOyj 9 4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ann & Keith Davey Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction;CSM <br /> 8543 Ellington Way, Middleton, WI 53562 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-467-4272 1/(Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Michael F. Simon Builders, Inc A Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 817 South Division Street <br /> (City,State,Zip) (City,State,Zip) \Setbacks <br /> Waunakee, WI 53597 / <br /> PHONE PHONE ❑ Site PI approval from <br /> 608-849-5916 app" bletownship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> builder@simonbuilds.com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:I/accessdane.co.dane.wi.usn <br /> f.ikkevation of property <br /> PARENT PARCEL NUMBER: CURRE ZONING: ACREAGE: <br /> ❑ PARCEL -7 r `G, - / /� ntage drawn to scale. <br /> NUMBER Q ! 05 51 -oi-/S O S(c� <br /> TOWNSHIP: SECTION: 1 , , i ❑ Driveway pe <br /> Town of Middleton /: +V . /a/a: W (state,co ,town) <br /> ADDRESS: <br /> 8543 Ellington Way, Middleton, WI 53562 <br /> CSM: LOT SUBDIVISION BLOCK/LOT C3 Sanitary mits <br /> (publ' , rivate) <br /> 35 Stonebrook Estates <br /> PROPOSED PROJECT INFORMATION AFF EVIEW <br /> PROJECT DESCRIPTION: - 41 V <br /> Addition to rear of home + _ f� a <br /> . ❑This project is a new building or structure. a er 'W •�se� ` <br /> ®This project is an addition/alteration to an existing building or structure. 7 . '141,97.1#11 W <br /> SANITARY SERVICE: PERMIT NUMBER: • •° $ <br /> ❑SEWER SEPTIC Existing - " <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) t, <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> •S ,���p @rrTNt t.t <br /> BASEMENT: 1ST FLOOR: u � R x: <br /> TOTAL SQUARE FOOTAGE: _ t ,_ <br /> 204 (unfinished) 364 j <br /> g e s <br /> 2ND FLOOR: 3RD FLOOR: - ��1 �'. �. �4 r,, <br /> _ 1R w�:, ruy° <br /> ESTIMATED CONSTRUCTION COST: •8 i•1 .• a'OSf ; <br /> (Please round to nearest dollar) - "+ 100,000.00 � 3t._. _. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 121 No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes tti No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? XI Yes ❑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 81 No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ®No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -► -i <br /> 545-112(4/08) <br />