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SUPPLEMENT to Web-App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Chad Niday ❑Zoning Sta us; P; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Rest • on;CSM <br /> 4271 Old Stone Rd Oregon,Wi 53575 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)501-4721 chad @ddclean.com InAte t SGa1@J 15 <br /> AGENT INFORMATION CONTRACTOR INFORMATION tf irldu t3 dimensions uf <br /> AGENT NAME CONTRACTOR NAME I _ <br /> Cleary Building Corp ❑Site PI in ding location ) <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s tic <br /> 190 Paoli St <br /> (City,State,Zip) (City,State,Zip) 0 Se $ .-• OI CJ N. I I( <br /> Verona,WI Peet ' e <br /> PHONE PHONE ❑Site Plan p r al from <br /> (608) 379-0132 applicab n ip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ❑ f pla t Call <br /> tleeser @dearybuilding.com c;LV(5 - <br /> PROPERTY/LOCATION INFORMATION (http:Naccessdane.co.dane.wi.us/) W t'i pleA) <br /> cl Elevation of• e 1, <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p <br /> ❑PARCEL 052/0510-204-9615-0 RH-4 �e ' " 'le. 6` <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Rutland 20 % SE %/4+/4, SE ❑Driveway permits , 2 <br /> nDORess: (state,county,town)ry <br /> 4271 Old Stone Rd Oregon, Wi ❑Sanitary permits <br /> CSM: 14,169 LOT 1 C_ rA SUBDIVISION BLOCK/LOT (p private) �7.. <br /> j� (public, nvate J hoa <br /> PROPOSED PROJECT INFORMATION .1 -. —.I. <br /> PROJECT DESCRIPTION: <br /> 40x56 cold storage shed , <br /> FdThis project is a new building or structure. ( ,�c <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER* � <br /> EWER .EPTIC ` � $ <br /> HEIGHT IN FE T .�/ NUMBER OF STORIES: (Not including basement) . � <br /> L// if , ,$y 1r 9 0 - . ■ ■ 3 <br /> 11111A TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> fi 1 ' Q."�i5 Y 0 3 � <br /> BASEMENT: 1ST FLOOR: <br /> 4, TOTAL SQUARE FOOTAGE. 4, <br /> 2ND FLOOR: 3RD FLOOR: <br /> 4 0.0 <br /> ESTIMATED CONSTRUCTION COST: Q k- :i �� <br /> (Please round to nearest dollar) $ 31,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓❑No ❑Don't know <br /> Elves 2. Is there a wetland or floodplain on or near the property? Yes ao ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes IgNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Lives 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 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓No <br /> • APPLICATION MUST B.E SIGNED <br /> F (Continue on Back) —► —► <br /> s4sttz la/oal to,. `--1-- y <br /> .�,1-7 ( ( -7 ok � yl I� <br />