Laserfiche WebLink
a <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) 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.usn ❑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 '/a: SW '//: NW ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> 3002 STATE HIGHWAY 73 53531 <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 9,493 1 (public,private) <br /> PROPOSED PROJECT INFORMATION :,4,4CY;r0:704EVVIZ <br /> PROJECT DESCRIPTION: !) <br /> 42x56 Storage shed i 0 ing District ,y 'yx " <br /> . 15I This project is a new building or structure. ti Permitted=Use? <br /> ❑This project is an addition/alteration to an existing building or structure. irg4s y% s. <br /> SANITARY SERVICE: PERMIT NUMBER: =❑y ..uralAddress ,,,i <br /> EWER [EPTIC (new/existing $ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 20.7 1.0 ❑ Vet anc/Floodpl fn/ <br /> ;` �4 SShoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: s;1, f <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) ` <br /> BASEMENT: 1ST FLOOR. <br /> ❑ ErQSionebntrol permit <br /> 4, TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> .filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2,352.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) "� ♦ ♦ ♦ i --► $ 80,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes IgNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? nYes FINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? UYes ONo <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 FANo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes iglNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> 545-112(4/08) <br />