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4, m FL dr., v(„4„, 1644 ce-E._ <br /> c&i, , <br /> • <br /> P-Cy . <br /> 'Dv, Jetetway. <br /> ,_, <br /> 6 -2 „4,,,, t tit to"vM l • C. I%tn2 c( <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Dawson Living Trust - Thomas and Erin Dawson ❑Zoning Status; CUP e.-1(.. <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; C <br /> 9714 Red Sky Drive, Middleton,WI,53562 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)826-4983 (608)220-3689 erinandtom @charter.net ❑Site Plan drawn Cale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includesOiffiensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building-Jay Gunderson ❑Site Plan inclig location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacl <br /> Verona,WI,53593 <br /> PHONE PHONE ❑Site PlanAp pirr om <br /> (608) 212-2129 applicabJlf?taiv s . <br /> E-MAIL ADDRESS E-MAIL ADDRESS / <br /> junderson@clearybuilding.com ❑ Floor planptb Scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of operty <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 080620380001 40.00 frontage r wn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Black Earth 1/4: '/a%a: ❑ Drivew o S <br /> (state, n'*, town <br /> ADDRESS: ( town) <br /> Reeve Road <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanityitral '. <br /> (pub v <br /> PROPOSED P ROJECT INFORMATION STAFF/REVIEW <br /> PROJECT DESCRIPTION: <br /> Agriculture build ❑ Zoning i ict <br /> 0 This project is a new building or structure. ❑ Permitt Use? <br /> ['This project is an addition/alteration to an existing building or structure. . 4::m• <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER EPTIC (new/existing) <br /> HEIGHT IN FEET_ _ - NUMBER OF STORIES: (Not including basement) <br /> IL\"!V 19.0 1.0 ❑ Wetland/FI••16. ;fain/ <br /> Shorela - ,-• ment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> ❑ ErosionControl permit <br /> T: <br /> .�t CU� 4, TOTAL SQUARE FOOTAGE: 4, (slo ^�ance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> ` fillin <br /> 1744CCO 1 ' ' ❑ Review Local Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and avail 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 151No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes '4No ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des FNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes '4No <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 ONo ❑Don't know <br /> 7. Is this to correct a violation? [Yes is <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) <br /> (Continue on Back) -i <br /> ° <br />