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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 /> Tim O'Brien Homes ❑Zoning atu ; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Res • tion; 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 awn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu s dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tim O'Brien Homes ❑Site Plan in .ing location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s,. i A <br /> 11 <br /> 2601 Crossroads Dr, Ste 140 <br /> (City,State,Zip) (City,State,Zip) ❑SettAs <br /> Madison,WI 53718 from <br /> PHONE PHONE ❑Site 14.4100/al <br /> 608-661-1100 applit r1 ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> clevy@tobhomes.com ❑ Floor pla 1?o scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of pr erty <br /> PARENT PARCEL NUMBER: CURB TZONING: ACREAGE: <br /> ❑PARCEL 038/0708-301-0056-0 ._-0 b 0.35 frontage dr n to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Middleton 30 1/4: NE 1/4: NE ❑Driveway pe Its <br /> ADDRESS: (state,county,town) <br /> to fBs-Manistee Way ❑6ry permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 6 Pioneer Pointe ,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Single Family Dwelling ❑ Zoning i rict <br /> • <br /> This project is a new building or structure. <br /> ❑ Permit.VI Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> F1TEWER r)EPTIC rsw/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 30.3 2.0 ❑ Wetland/F1oplain/ <br /> Shorelatcl ( achment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 1,315.0 1,441.0 4 TOTAL SQUARE FOOTAGE: + (slopes(Js rbance, <br /> 2ND FLOOR: 3RD FLOOR: n, filling/access) <br /> 1,492.0 424 ❑ Revie Lo n Survey <br /> ESTIMATED CONSTRUCTION COST: -o. ♦ -o. ♦ $ 467 105.00 and av 'lations. <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 IZEINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes TiNo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Wes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes po <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) Ofres ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Iifo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -* -- . <br /> REV(01/19) <br />