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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 /> Christopher Doll <br /> OWNER ADDRESS (Number,Street,City,State,Zip) 51 Zoning Status;CUP; -- <br /> 7489 Valley View Rd,Verona,WI,53593 Deed CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (414)520-1380 chrisadoll @gmail.com 15 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions ` /fir <br /> AGENT NAME CONTRACTOR NAME 5 <br /> AGENT ADDRESS CONTRACTOR ADDRESS oft well/septiluding location , <br /> (City,State,Zip) (City,State,Zip) Setbacks /79/2 D <br /> PHONE PHONE 'Site Plan approval from <br /> G <br /> applicable township. 4 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> KFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) M't PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of property <br /> ❑PARCEL 038/0708-321-8550-1 A-1 2.46 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Middleton 32 1/4; NE WA: NW 125Driveway permit <br /> ADDRESS: (state,county,cinW <br /> 7489 Valley View Rd, Verona, WI, 53593 <br /> CSM: LOT SUBDIVISION BLOCK/LOT unitary .1•1 <br /> 4,812 1 (public, - <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ,�,(� ,( <br /> Back Addition-Office,Storeroom,Kitchen,Bath,Screen Porch Of -Zoning.Zoning District /3- <br /> . ❑This project is a new building or structure. 0 Permitted Use ofk <br /> 4 This project is an addition/alteration to an existing building or structure. S FiC- <br /> SANITARY SERVICE: PERMIT NUMBER: 4 Rural A.• -'�! <br /> EWER JEPTIC (new/ea'=' <br /> HEIGHT IN FEET: 4 7 NUMBER OF STORIES: (Not including basement) W oodplain/ A./A_ <br /> attachment) /" <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade dec or porches) T <br /> FrosionControl permit / r <br /> BASEMENT: 1ST FLOOR: / <br /> 647.0 + TOTAL SQUAB FOOTAGE: + (slopes,disturbance, �' <br /> 2ND FLOOR: 3RD FLOOR: filling/access) / <br /> 647.0 ,Review Location Survey I <br /> ESTIMATED CONSTRUCTION COST: ♦ -+ ♦ ♦ ♦ ♦ A 60,000.00 <br /> 000.00 and available options. P/,¢- <br /> (Please round to nearest dollar) $ , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes tato ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EINo ['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 ❑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 EVo ❑Don't know <br /> 7. Is this to correct a violation? Des OW <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -- —► <br /> 545-112(4/08) <br />