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• <br /> SUPPLEMENT to Web•App# <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Tom Steffen <br /> ['Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 3002 STATE HIGHWAY 73 53531 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (806)268-0051 pioneer @xit.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli St <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Verona,WI <br /> PHONE PHONE ['Site Plan approval from <br /> (608) 379-0132 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tleeser @clearybuilding.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 016/0612-033-8685-0 RH-1 3.76 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Christiana 3 IA: SW 1h1A: NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3002 STATE HIGHWAY 73 53531 <br /> CSM: n A 93 1 LOT SUBDIVISION BLOCK/LOT <br /> 7 ['Sanitary permits <br /> �F (public, private) <br /> PROPOSED PROJECT INFORMATION ;;,445, TA VIEW <br /> PROJECT DESCRIPTION: '''''''' ` .' <br /> 42x56 Storage shed ❑ Zoning District , <br /> . This project is a new building or structure. 0 Permitted Use ? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 0 Rural Address ar�4 <br /> (new/existing EWER KEPTIC - <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 20.7 1.0 0 Wetland/Floodpla+ %;, <br /> AREA TO NEAREST SQUARE FOOT: S dr @IaCl ,,a � 811t <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) - <br /> BASEMENT 1ST FLOOR: Q ECOStonC©rttrol permit <br /> Z 3 5---/- 4, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 2,352.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) -0. -10- <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes INNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? nYes Mho <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? nYes 1g No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# �G 3 Z) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) nYes pi No ❑Don't know <br /> 7. Is this to correct a violation? nYes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —+ -i -i <br /> 545-112(4/08) <br />