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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Jeffrey Lang <br /> oning Status; CUP; <br /> ° i A RESS (N ber, t City,State, Deed Restriction; CSM <br /> bountyoac;�Verona, I, 53593 <br /> / Variance(# ) <br /> HOME PHONE CELL P O E-MAIL ADDRESS <br /> 6L�-� 0-1809 jjlang06 @hotmail.com • Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME C I�TI�CTO�g,,N�tAME <br /> �ieTTes ITOfStUCtiOn Si an including location <br /> AGENT ADDRESS C ITT—�OI��QDfjF,$i well/ ptic <br /> (City,State,Zip) ( i 4 SStatue,IIZ fir--{{�U 11jj backs <br /> Inerau Oint, WI 53565 <br /> HONE PHONE 608-987-3534 El Site n a royal from <br /> appli township. <br /> E-MAIL ADDRESS E-MAIL A R S <br /> tee -88 @hc-t nail.com oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) E ation of property <br /> PARENT P g �,�yL►p� g CURRE TZON G' procw. <br /> 0NUMBER �4 /d t I2 9605-6 �-1 (gX) q,p'-� ronta drawn to scale. <br /> SHIP: SECTJt SE NW rive ermits <br /> • Monrose l 1/4: /</4. <br /> (s ,co ty,town) <br /> ADDRESS: 7814 County Rd A, Verona <br /> unitary permits-.., <br /> CSM: Le SUBDIVISION BLOCK/LOT (public,private) "9 <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> P O EC ESCRIPT N: <br /> POole barn, A cold storage �c X 40 __ oning District <br /> . Q✓This project is a new building or structure. 13-P'ermitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUIy1BER Li Rural Address <br /> EWER EPTIC N (ne Sin <br /> HEIGHT IN FEET: NUMBER OF ORES: (Not including basement) <br /> )(0'41'1 0„" VDT- PeaK 1 ❑ We a /FI dplain/ <br /> Shorela (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) rosi O OI permit r <br /> BASEMENT: 1ST FLOOR: 3000 TOTAL SQUARE FOOTAGE: j (slope sturbance, ��' <br /> fllli acce ) ', <br /> 2ND FLOOR: 3RD FLOOR: 3000 <br /> eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �1 I �p0. OD and available op ti ns. <br /> (Please round to nearest dollar) t <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ✓�Jo �on't know <br /> 2. Is there a wetland or floodplain on or near the property? Des ,/No EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des _No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Des TVo <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) Des to Jon't know <br /> 7. Is this to correct a violation? Des ✓No <br /> 33 c /Q 3 APPLICATION MUST BE SIGNED <br /> 4, . (Continue on Back) ♦ —► <br /> 545-„2 t4,08> ` �lk <br />