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6c.i.6 ( 5O <br /> ZONING PERMIT APPLICATION www.countyofdane.com Fir:=CME=0 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Tim O'Brien Homes ❑Zoning Stat ; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed riction; CSM <br /> 2601 Crossroads Dr,Ste 140, Madison,WI 53718 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-661-1100 clev • tobhomes.com ❑Site Plan dr n to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and incl s dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tim O'Brien Homes ❑Site P I ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of w I I <br /> 2601 Crossroads Dr,Ste 140 �` <br /> (City,State,Zip) (City,State,Zip) ❑S 4W ks 1.....5Madison,WI 53718 1/ <br /> PHONE PHONE ❑Site Plan �f� L€!Om <br /> 608-661-1100 applicablptbv s 1p. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> clevy@tobhomes.com ❑ Floor pl /scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wi.usl) ❑Elevat' n property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 111 PARCEL 038/0708-301-6049-0 0.48 frontag rawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Middleton 30 1/4: SE 1/4: NE n Drive a ermits /tpp�� <br /> ADDRESS: (f <br /> (state, unty,town)1 iLL <br /> ITU Colonial Way <br /> zL�� ❑San' - permits <br /> CSM: LOT 59 SUBDIVISION BLOCK/LOT p :lic private) <br /> Pioneer Pointe <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Single Family Dwelling ❑ Zoning is Ct <br /> . <br /> This project is a new building or structure. ❑ PermittVlse? <br /> This project is an addition/alteration to an existing building or structure. VV <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RUral Address <br /> IT4EWER <br /> �EPTIC ` v/existing).J <br /> HEIGHT IN EEWNUMBER OF STORIES: (Not including basement) <br /> /i <br /> 29.0 2.0 LI Wetland/Floodplain/ <br /> Shorelat/ tvtachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1,680.0 1 1ST FLOOR: lore g0 „54 �i + 1 ❑ ErosionControl permit <br /> JhSI„T16 TOTAL SQUARE FOOTAGE: (Slop cgisiurbance, <br /> 2ND FLOOR: 3RD FLOOR: flllln a cess) <br /> 874.0 80'0 Pj9`sS❑ Re 'e �,Q n Survey <br /> ESTIMATED CONSTRUCTION COST: and ble options. <br /> (Please round to nearest dollar) ♦ ♦ -+ ♦ ♦ -+ $ 501,841.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ENO ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [—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) Dies ❑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 />