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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 /> Ross Berning oning Status; CUP; <br /> NER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7205 Cross Country Rd,Verona,WI 53593 Vari e(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)279-3129 <br /> (608)279-3129 rossberning @gmail.com Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Owner Owner a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s tic <br /> (City,State,Zip) (City,State,Zip) acks <br /> PHONE PHONE ❑Site ' -• ..proval from <br /> ap• • -.le -. nship. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> oplans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El tion of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P Y <br /> ❑PARCEL 0608-161-8520-3 R-1 X5-73 1.00 stage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Verona 16 1/a: NE 1/41/,_ NW • = ' - a s-rmits <br /> ADDRESS: (Stat" .. ty,town) <br /> 7205 Cross Country Rd Verona, WI 53593 <br /> CSM: / V • SUBDIVISION BLOCK/LOT <br /> I=1 S.• per ••s <br /> a (public, • ' ate) <br /> PROPOSED PROJECT INFORMATION AFF - VIEW <br /> PROJECT DESCRIPTION: <br /> Backyard shed //1,)'/.G oning District <br /> . 0 This project is a new building or structure. P fitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: rai Addr- s <br /> EWER [EPTIC (new Isting) l <br /> HEIGH�IN�E /� NUMBER OF STORIES: (Not including basement) <br /> (r}'-\� 12.0 1.0 r e ..d/F oo•plain/ <br /> AREA TO NEAREST SQUARE FOOT: hor: . ac.ttachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) e <br /> osionControl permit 1 <br /> BASEMENT 1ST FLOOR: ' t <br /> 224.0 4, TOTAL SQUARE FOOTAGE: + (slopes,disturbs e, ,, <br /> 2ND FLOOR: 3RD FLOOR: full / cceSS) :CI <br /> 224.0 <br /> / eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ and available options. <br /> ♦ ♦ <br /> (Please round to nearest dollar) $ 7,500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a and or lake? ✓ es No Dons\t ow <br /> P p Y pond ❑�' ENo ❑ <br /> 2. Is there a wetland or floodplain on or near the property? Dies ENo ❑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 ONo ❑Don't know <br /> 7. Is this to correct a violation? Elves ONo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) —► <br />