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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 /> Ram and Chetna Venkatesh ❑✓ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 9710 Trappers Trail, Middleton, WI Variance(# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> (608)772-9710 ram_venkatesh@hotmail.com ❑✓ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Brian McKee Midwest Homes Inc ❑✓ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 925 Watson Ave <br /> (City,State,Zip) (City,State,Zip) ❑✓ Setbacks <br /> Madison WI 53713 <br /> PHONE PHONE <br /> ❑✓ Site Plan approval from <br /> (608) 271-4900 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS �` ❑✓ Floor plans to scale <br /> brianmckeemidwesthomesinc.com <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El <br /> ❑PARCEL 0608-263-8355-0 RR4 2.33 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: .f")v .� <\J; <br /> Verona 26 1/i: sblfi- /a� : ,Sys/ ❑✓ Driveway permits <br /> (state,county,town) <br /> ADDRESS: ,,?,1? County Hwy 'PB' j 91' ❑✓ Sanitary permits <br /> CSM: 14,662 LOT 3 SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New single family home constrcution �� `H-i � C �� _� , Zoning District <br /> . ['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 /> I—TEWER {EPTIC 13,202,100,072 ((new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 29.0 1.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit <br /> BASEMENT: 2,1 83--0- 1ST FLOOR: 3,^87.0 <br /> r. lJ. TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> ia �� filling/access) <br /> 2ND FLOOR: 3RD FLOOR: u <br /> 0.0 0.0 t��( -3,987-70 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -+ ♦ -+ 754 339.00 and available options. <br /> (Please round to nearest dollar) , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [fres ✓❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑✓No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [fres ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [fres ✓❑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 i" ✓❑No' ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 1=1No <br /> ( APPLICATION MUST BE SIGNED <br /> ,�, G <br /> ?,...:. <br /> v (Continue on Back) -► -i —t.REV 101/191 <br />