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�. �c r3 ' 0 2m coG Gq <br /> _ 7 <br /> ., .... DANE COUNTY JOA o/1 i3O 7P-- <br /> '4CONe <br /> ZONING PERMIT APPLICATION "11WW.DANE000NT PLANNING.COM <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Justin & Samantha Berezowitz <br /> ['Zoning Status; C P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Rest icti ; CSM <br /> 9520 Dregers Way Verona WI 53593 Variance(4, ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (262)945-1017 (414)303-7616 ssadowski1590 @outlook.com n Site Plan draw to ale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes di sions <br /> AGENT NAME CONTRACTOR NAME <br /> Jason Thomas Homes LLC ❑Site Pla i cluding location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s tic <br /> 7521 Hubbard Ave <br /> (City,State,Zip) (City,State,Zip) ❑Set cks <br /> Middleton WI 53562 <br /> PHONE PHONE ❑Site proval from <br /> (608) 203-5592 appIcM wnship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> • michelle @jasonthomashomes.com ❑ Floor pl n to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) ❑Elevatio of operty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 0607-083-8440-0 RR-2 2.52 frontage Yawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Springdale 8 1/4: NE V/4: SW ❑ Drivew y ermits <br /> ADDRESS: (state, unty,town) <br /> Lot 3 Town Hall Road a7)Cf.5 T00 Cr iat <br /> GSM: 15 133 LOT 3 SUBDIVISION BLOCK/LOT ❑Sanitary ml <br /> W <br /> Wit <br /> indy Ridge Farm (public, p to <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single family home, new construction ❑ Zoning Dig t,/ <br /> Q Thi s project is a new buildin g or structure. <br /> ❑ PermitteVse? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: LI '• .1 Address <br /> (EWER [EPTIC 13,202,200,283 f"(new existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) •23.0 1.0 A - land/ Its a / <br /> Shorela d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1 518 1ST FLOOR: 2 488 ❑ Efosl•n • O permit <br /> 4, TOTAL SQUARE FOOTAGE: 4, (510.,? . bance, <br /> 2ND FLOOR: 3RD FLOOR: flllln /a. SS) <br /> 4,006 <br /> LI Revie .L.ti• Survey <br /> ESTIMATED CONSTRUCTION COST: _ —• ♦ ♦ ♦ ♦ 974 967 and a : . : : options. <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 riNo 4Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes ❑No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? nYes NINo <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) nYes nNo Don't know <br /> 7. Is this to correct a violation? Elves ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -4 —► —► <br /> REV(01/19) <br />