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(c (2-0 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Chris Lawn ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7632 Summerfield Dr.,Verona,WI 53593 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)827-8970 (608)354-5955 lawnxc@gmail.com ❑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/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> WA PARCEL 0708-191-2201-0 A-1 1.12 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Middleton 19 1/,: NE %+/4. NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 7632 Summerfield Dr. <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> Fawn Ridge 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> deck ❑ Zoning District <br /> . ['This project is a new building or structure. <br /> ❑ Permitted Use? <br /> IN This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER }EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: �STFLOOR: ❑ ErosionControl permit <br /> j, TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 216.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ ♦ "♦ "r ♦ $ 1,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes no EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? DYes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ❑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 [lo [on't know <br /> 7. Is this to correct a violation? DYes [Vo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ ♦ -i <br /> 545-112(4/08) <br />