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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Robert & Ami Kreger <br /> [ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2100 Korgen Drive Stoughton WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 206-3752 rob.kreger@gmail.com ami.kreger@gmail.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. n 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) n Setbacks <br /> Wauanakee WI 53597 Waunakee Wl53597 <br /> Site <br /> PHONE C lan approval from <br /> (608) 849-6770 PHONE (608) 849-6770 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeanette@premierbuildersinc.com jeanette@premierbuildersinc.com n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> [PARCEL 0611-291-0634-8 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Pleasant Springs 29 1/4: NE 1/4: NE n Driveway permits <br /> ADDRESS: (state, county, town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT n Sanitary permits <br /> 4 (public, private) <br /> Squire's Rolling Meadow <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Home Construction ❑ 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: U Rural Address <br /> EWER ig.EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 25.0 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 /> BASEMENT: 1ST FLOOR: ❑ Erosion Control permit <br /> 2,404.0 4,055.0 ,,, TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 6459 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ $ 650.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes [No []Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes fNo [Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? F7Yes [No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes n✓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) QYes No [Don't know <br /> 7. Is this to correct a violation? EYes [No <br /> APPLICATION MUST BE SIGNED <br /> REV(01/19) (Continue on Back) —1 —o- —o- <br />