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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME CAMERON M SZYCHLINSKI <br /> © Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> `.? 3914 SWOBODA RD,Verona,WI 53593 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (414)305-3054 (414)305-3054 cszychlinski @yahoo.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> IN Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) IN Setbacks <br /> , . ,, ...„PHONE ~ PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> NI Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 0 Elevation of property <br /> ❑PARCEL 070819162000 A-1 0.92 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: `` <br /> TO7NRO8E 19 1A: SE 1/4+/4. NE ❑D iyeviay permits <br /> /ADDRESS: (state,countdown) <br /> \,, 3914 SWOBODA RD, VERONA, WI 53593 <br /> CSM: LOT SUBDIVISION BLOCK/LOT I=1 Sani� •ermits <br /> 1,486 54 Cardinal Point Estates (p t c, •rivate) <br /> PROPOSED PROJECT INFORMATION AF• REVIEW <br /> PROJECT DESCRIPTION: <br /> New Deck Arj`„r� oning istrict <br /> . 19 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: Rural Address <br /> EWER r)EPTIC , (ne --4 ' - <br /> IGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> %' W Shor- (attachment) <br /> ./ •=:plain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> - <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> Erosion • trol permit <br /> 33 4, TOTAL SQUARE FOOTAGE: j (Slopes, • sturbance, <br /> 2ND FLOOR: 3RD F OR filling/a '- ) <br /> /// 360.0 Revie Lotion Survey <br /> ESTIM RUCTION COST: ♦ and av ble options. <br /> (Please. D CONSTRUCTION <br /> round to nearest dollar) $ 23,000.00 <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 /> 2. Is there a wetland or floodplain on or near the property? Dies Elo ❑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 1DNo <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 Jlo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545-112(4/08) <br />