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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 /> Daniel Pietrzykowski <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 7811 Manistee Ct.Verona,WI 53593 <br /> Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)237-1714 (608)219-8997 dpietrzykowski @yahoo.com <br /> ['Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> n/a n/a ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) [Setbacks <br /> PHONE PHONE [Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> [ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑PARCEL 038/0708-302-0253-0 R-1 0.74 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Middleton 30 1/4: NW 1/41/4: NE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 7811 Manistee Ct. Verona, WI 53593 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> Cherry Wood Park 33 <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 24'x 32'garage ❑ Zoning District <br /> 12 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 /> FIEWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: t NUMBER OF STORIES: (Not including basement) <br /> ❑ Wetland/F000dplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Li ErosionControl permit <br /> BASEMENT: 1ST FLOOR: p <br /> 768.0 1, TOTAL SQUARE FOOTAGE: ,j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> 768.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ -� ♦ $ and available options. <br /> (Please round to nearest dollar) $ 6,900.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑✓Yes [No ElDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes E✓No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes Ekslo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes ❑No <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 ✓ to ❑Don't know <br /> 7. Is this to correct a violation? [Yes ✓❑No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />