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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 /> Wayne Neidigh ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3585 Mathias Way Verona,WI 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)620-5705 (608)469-2891 wayne @neidigh.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑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/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 038/0708-302-7254-5 residential o • 6312 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Middleton 3o 1/4: '/1/4: ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> D,4- Garr W cod (public,private) <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJECT DESCRIPTION: <br /> Above ground pool 'U•Zoning District <br /> ❑This project is a new building or structure. �� A ,-- <br /> qPermitted;Use2' �A , , <br /> ❑This project is an addition/alteration to an existing building or structure. z-, ;,t ,4. <br /> SANITARY SERVICE: PERMIT NUMBER: ` uralAddres "1f4 3 <br /> EWER [EPTIC .- @ ew/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 5 Cd Weflancyfbadp in/ <br /> AREA TO NEAREST SQUARE FOOT: relanattachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionCo trot permit <br /> 4, TOTAL SQUARE FOOTAGE: + filling/a c eSs)(slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: / <br /> 5 �x <br /> 6 L] , o*L9coon rvey. <br /> ESTIMATED CONSTRUCTION COST: aval�ptfs <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 0 CPC, ,,' o <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes FdNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes allo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓1'es ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ONo <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 ENo DDon't know <br /> 7. Is this to correct a violation? f ❑Yes rANo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► <br /> 545-112(4/08) <br />