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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 /> Matthew Becker, Maria Signore Becker <br /> ❑Zoning Status. P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Re ' tion; CSM <br /> 17 Pilgrim Circle Madison WI 53711 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 849-6770 ❑Site Plan ra to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu dimensions <br /> AGENT NAME CONTRACTOR NAME . II <br /> Jeanette Acker Premier Builders Inc ❑ i Plcl in lortjc�ry>, <br /> AGENT ADDRESS CONTRACTOR ADDRESS o Well/s ti �'�/ <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 /> El Site PI p val from <br /> PHONE (608) 849-6770 PHONE (608) 849-6770 applicObb eIt'iiw ship. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> jeanette@premierbuildersinc.com jeanette@premierbuildersinc.com ❑ Floor pla s o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevati n property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ElPARCEL 0708-303-2076-0 frontag rawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Middleton 30 1/4: NW 1/4: SW ❑ Drivew y rmits <br /> ADDRESS: (state,c unty,town) <br /> 7?3 LI <br /> 8 vr'. ne `'` ' ❑ Sanitary pe its <br /> CSM: LOTSUBDIVISION BLOCK/LOT <br /> 14,093 2 (public, p . ate) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Home Constructgion ❑ Zoning9Ktrict <br /> . ❑✓ This project is a new building or structure. ❑ Permittd Jse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC e existing) <br /> HEIGHT INF ET: / NUMBER OF STORIES: (Not including basement) <br /> '� 0 3.0 ❑ etlan /Flo plain/ <br /> Shoreli� a chment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including finished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 1 ,352.0 2,273.0 + TOTAL SQUARE FOOTAGE: + (Slopeg rbance, <br /> / filling <br /> 2ND FLOOR: 1 ,170.0 / 3RD FLOOR: .3;4- 6q--mg <br /> VV (}'j ❑ Re 'eat' n Survey <br /> ESTIMATED CONSTRUCTION COST: -4. -4. -1. •-o. ♦ $ r 0 �D and i b p I s. <br /> (Please round to nearest dollar) �J <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes fNo ['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? ✓❑Yes ENO <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) Efres ❑No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -► <br /> REV(01/19) <br />