Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Jeffrey Lang <br /> �w� oning Status; CUP; <br /> WT Aeounty oad, verona'W I, 53593 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CE262°9130-1809 E-MAIL ADDRESS <br /> Ian 06 @hotmall.COm <br /> y �j g e Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> C �awn C <br /> AGENT NAME l I em <br /> Ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic ^ /R.-hit . <br /> 5353 i c' I`fj'{ e.(1,r- <br /> City,State,Zip) (City,State,Zip) laSgTacks e II O 4 <br /> 5oc ► o 11•C trJF , <br /> PHONE PHONE 608-574-0667 0 Site Plan royal from <br /> appli a township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> .-t •, 4. Id $ C oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT P CURRE T 0 AC—"'-: E Ion of property <br /> 0 PARCEL -9605-6 -�i �C) ci.p�.�. rontage drawn to scale. <br /> NUMBER TOWNSHIP: SEC <br /> Monrose ,: <br /> SE NW 0 Driv ay rmits <br /> . Monrose %4. SE ,�4,�4: NW ❑Driv ay rmits <br /> (s t unty,town) <br /> ADDRESS: 7814 County Rd A, Verona r <br /> nita s <br /> CSM: LOT SUBDIVISION BLOCK/LOT :=t5 <br /> t. (publi•,pnva - <br /> PROPOSED PROJECT INFORMAT:CA STy F REVIEW <br /> fackec' a t� J,th a Space. 4 mg . .ct <br /> . Q✓This project is a new building or structure. p led Use? <br /> QThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural - . <br /> EWER TEPTIC (n_ /existi • <br /> HEIGHT IN FEET: �� NUMBER / STORIES: (Not including basement) _ d/F plain/ <br /> Sh• -- d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) U Eros• ontrol permit <br /> BASEMENT/Gov& 1ST FLOOR: <br /> 9e 1 I/ O +, TOTAL SQUARE FOOTAGE: j (S rbance, <br /> 14,o I �O 4 "01 �j • ., ) <br /> 2ND FLOOR: J 3RD FLOOR:/ eview Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ -* ♦ -�► $ �`�O and available options. <br /> (Please round to nearest dollar) '\ <br /> /Va <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Bes Elio �on't know <br /> 2. Is there a wetland or floodplain on or near the property? es o on't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes ✓I o <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 go EDon't know <br /> 7. Is this to correct a violation? Yes o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -♦ ■ -► <br /> 545-112(4108) <br />