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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 /> Dale Leibowitz zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,ZIP) Deed Restriction; CSM <br /> 2201 Lakeland Ave <br /> _.__._...__—_._._....__..._........"_-..."__.._._._._................__..._...__..._. Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)658-3788 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp Cleary Building Corp Site Plan including location <br /> AGENT ADDRESS mm _— CONTRACTOR ADDRESS mm of well/septic <br /> 190 Paoli St, PO Box 930220 190 Paoli St, PO Box 930220 <br /> (City,State,Zip) (City,Stale,zip) IN Setbacks <br /> Verona,WI 53593 Verona, WI 53593 <br /> El Site Plan approval from <br /> PHONE (608) 845-9700 PHONE (608) 845-9700 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jgunderson @clearybuilding.com jgunderson @clearybuilding.com MI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dano.wLus/) Q Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING. ACREAGE. <br /> 0 PARCEL 0810-191-6089-6 c-2 5.90 frontage drawn to scale. <br /> NUMBER —_ <br /> TOWNSHIP: SECTION: <br /> town of Burke 19 +/4: NE' 1/41/4: SE Driveway permits <br /> _.__ ._._._,.. .._. _._._.__..........____._.._.____—......_ _ state,county,town) <br /> ADDRESS: <br /> 4578 Dovetail Dr <br /> JKSanitary permits <br /> CSM: LOT n SUBDIVISION BLOCK/LOT <br /> 9 (public,private) <br /> Dovetail Subdivision <br /> PROPOSED PROJECT INFORMATION ST4FFRE'VIEW <br /> ffi -4 E. <br /> PROJECT DESCRIPTION: ";#10,-,14-4,: , <br /> ���k s <br /> Cold storage garage 2 .irlg *1:0 '_' / <br /> . IN This project is a new building or structure. tte set <br /> El This project is an addition/alteration to an existing building or structure. .' 5 \., <br /> __ ..__. -.... - . ..... _ —_.... U Rurat ad' <br /> SANITARY SERVICE: PERMIT NUMBER: ,`� , <br /> iI EWER DEPTIC (ne existing Cjv <br /> HEIGHT IN FEET. , NUMBER OF STORIES. (Noi!ncludmg basement) <br /> 18.Rk, 1.0 Wetland/Floodplain/ <br /> W oreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: :, <br /> (Outside dimensions including area,attached garages and above grade decks or porches) <br /> ___ _._.._.._...__._. _............___._. .............__..___. . ___._..._..._._._-. ErosionControl permit <br /> BASEMENT: 1ST FLOOR: V� <br /> 972.0 ,+, TOTAL SQUARE FOOTAGE: 4, '(slopes,disturbance t5 <br /> ____..._._....____"."_....____.___.._.._-- _._""..._ __-____.._.._......._.._..........—_.._......._._-.- fi ino/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 972.0 Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q 75,000.00 and available options. <br /> ♦ <br /> (Please round to nearest dollar) -4* -+ ♦ -/* .4. $ <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? CYes ✓[, lo :Don't know <br /> 2. Is there a wetland or floodplain on or near the property? EYes :No :Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? .., EYes DNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? EYes ✓alo <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# g97 ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) [✓Yes CNo CDon't know <br /> 7. Is this to correct a violation? :Yes Es No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► <br /> °.45.112!4I(-S} <br />