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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 <br /> D Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Dee R-striction; CSM <br /> 2601 Crossroads Dr,Ste 140, Madison,WI 53718 Varityyk(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-661-1100 clev • tobhomes.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inI les dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tim O'Brien Homes ❑Site I ' cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of V� <br /> 2601 Crossroads Dr, Ste 140 <br /> (City,State,Zip) (City,State,Zip) ❑SeriKgs <br /> Madison,WI 53718 <br /> PHONE PHONE ❑Site PIS al from <br /> 608-661-1100 applic ship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> clevy@tobhomes.com ❑ Floor plarscale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevatio 0 operty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 038/0708-301-0155-0 �g 0.33 frontage rawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Middleton 30 /4: NE 1/4: NE ❑ Drivewa p Its <br /> ADDRESS: (state,c ty,town) <br /> acr/ •Wrlit9 Manistee Way <br /> ❑S- : permits <br /> CSM: LOTSUBDIVISION BLOCK/LOT <br /> 65 <br /> Pioneer Pointe pu•II,,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Single Family Dwelling ❑ Zonin strict <br /> . ❑This project is a new building or structure. ❑ PermitVUse? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC UVJ(V/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 26.7 1.0 ❑ Wetla oodplain/ <br /> Shor (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ Erosio • trol permit <br /> BASEMENT: 1ST FLOOR: <br /> 2,352.0 2,527.0 + TOTAL SQUARE FOOTAGE: 4 (SIO r•ance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1� 2162414 <br /> ❑ Revie Loc on Survey <br /> ESTIMATED CONSTRUCTION COST: $ 613,622.65 an ptions. <br /> ♦ <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 [J t o ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [fres PZ o ❑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? fres [QI�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 go ❑Don't know <br /> 7. Is this to correct a violation? [ Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ ♦ -► <br /> REV(01/19) <br />