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A --i-A. (4p.-0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME IF-12- 8 <br /> Tim O'Brien Homes ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM v <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 drawn to scale V <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tim O'Brien Homes ❑Site Plan including <br /> cath i <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic ,�� <br /> 2601 Crossroads Dr, Ste 140 <br /> (City,State,Zip) (City,State,Zip) D Setbacks V <br /> Madison,WI 53718 <br /> PHONE PHONE ❑Site Plan p .4rom <br /> 608-661-1100 applicabl t s Ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> clevy@tobhomes.com 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 038/0708-301-6060-0 0.50 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Middleton 30 1/4: SE 1/4: NE ❑Driv w y permits <br /> ADDRESS: need <br /> (Stat county,town <br /> 7be 1 TIM Colonial Way <br /> 0 San' - permi <br /> CSM: LOT 60 SUBDIVISION BLOCK/LOT <br /> Pioneer Pointe f• private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Single Family Dwelling ❑ Zonin i r ct <br /> • OThis project is a new building or structure. ❑ Permitted] <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER SEPTIC /existing) <br /> HEIGHT IN FEET: 1 NUMBER OF STORIES: (Not including basement)theigAit � <br /> 29.3 2.0 ❑ Wetla odplain/ <br /> Shari (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached .arages and above grade decks or porches) <br /> BASEMENT: / 1ST FLOOR: ❑ ErosionContr I permit <br /> 1,684.0 �1 1,: : .0 .+1 g j TOTAL SQUARE FOOTAGE: ,, (slopes,�l ttrance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 734.0 1 241.00 Qp 6 V Li Review tion Survey <br /> ESTIMATED CONSTRUCTION COST: $ 50O 593.00 and aa> tions. <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? ❑Yes 1: o ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EgNo ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement'? gips ❑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 r►2No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes [gUo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -9 -r <br /> REV(01/19) <br />