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ZONING PERMIT APPLICATION 1.,ww.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Pres ibrN Rod ri 8 ue z 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3 ac 7 Meadow iZd+• Vega_ WI 5 354 3 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> GP-DVS t '3‘,04C, cod r s kteze,41014 kfft44'( • "" 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> El Site Plan including location <br /> AGENT ADDRESS CONT CTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,Sta e,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRE T ZONING: ACREAGE: <br /> ElPARCEL 0-7 08 — 321?-1841) A r Z 1. 3y frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Tow(; o4 m;dd<<. 32-7-8 %4:NW/SE %Y4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3a°1 7 -Qc d ow zd, Verona 'In)I 535-4 3 0 Sanitary permits <br /> CSM:00 32'4 LOT 1 SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION = STAFF REVIEW <br /> PROJECT DF,SCRIPTION: <br /> 5 hoed( 19-')( 14i CI Zoning District <br /> . lgrhis project is a new building or structure. 0 Permitted Use? <br /> ❑This project is an addition/alteration to an existi g building or structure. <br /> SANITARY SERVICE: PERMIT'DUMBER: U Rural Address <br /> DEVVER PEPTIC (new/existing) <br /> HEIGHT IN FEET NUMBE OF STORIES: (Not including basement) <br /> to.R. 0 Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: 0 £ <br /> 1 pl i x 1{,( 1 4 TOTAL SQUARE FOOTAGE: 4 (s disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: I.9 a -Pi' <br /> elf 0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: j> <br /> (Please round to nearest dollar) '* '∎ ♦ —0 '♦ "■ S a , 0 0 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? es Dlo 2 Don't know <br /> 2. Is there a wetland or floodplain on or near the property? es I o Don't know <br /> 3. Have you talked with the township about your proect and are they in agreement? es • • <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des Q o <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if non- <br /> 6. Is a location survey required? (see reverse) Des ■ o ,7y; �on't know <br /> 7. Is this to correct a violation? 11Yes 1 o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> S4t11.?rema, <br />