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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME TOWN OF VERONA <br /> 0 Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 335 N.NINE MOUND RD.;VERONA,WI 53593 Variance(# 2'"° ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS CuP Z31L+ /A—Z. <br /> (608)845-7187 AARNOLD@TOWN.VERONA.WI.US w( <br /> Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> TIM HOMAN J.P.CULLEN&SONS,INC. <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 319 JENNA DRIVE 330 EAST DELAVAN DRIVE <br /> (City,State,Zip) (City,State,Zip) Q Setbacks <br /> VERONA,WI 53593 JANESVILLE,WI 53593 <br /> PHONE PHONE IS Site Plan approval from <br /> (608) 417-9331 (608) 754-6601 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> TIM @HOMANCM.COM NICK.HERR @JPCULLEN.COM IS Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> ❑PARCEL 0608-082-9220-0 A2 18.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> VERONA 8 ��• SW 1h1/4: NW Driveway permits <br /> ADDRESS: (state,county,town) <br /> i 7685 CTH PD <br /> CSM: LOT SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> NA NA (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: <br /> TOWN HALL BUILDING • Zoning District <br /> 0 This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER JEPTIC 13-2016-00097 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 24.0 1.o ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: T <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> ^❑ ErosionControl permit <br /> 6,250.0 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 6,250.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) –I. -0. —∎ ♦ –10. $ 2,091,741.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ONo ❑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? [Yes 51 No <br /> 5. Is this project associated with a rezone/C F1lv4rlar ce etik appeal#23" ) (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 12 No <br /> Li AY 1 1 2016 <br /> APPLICATION MUST BE SIGNED <br /> 5a�112 ia;oel * �°�."..)-*45-.;'l*:' (Continue on Back) ♦ - -+ <br />