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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Tom Steffen ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3002 STATE HIGHWAY 73 53531 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/) 111 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 l/a: SW 1/4%: NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3002 STATE HIGHWAY 73 53531 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 9,493 1 (public,private) <br /> PROPOSED PROJECT INFORMATIONS STAFF REVIEWS PROJECT DESCRIPTION: <br /> 42x56 Storage shed L Zoning"OistnC <br /> . 0 This project is a new building or structure. <br /> ❑ Permitted,use7 ; <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ID Rural Address <br /> EWER [EPTIC ' (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 20.7 1.0 © Wetland/Floodpiatn/ <br /> Shoreland'(attachment}'. <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: <br /> 0 ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: + '(Slopes;,disturbance, <br /> 2ND FLOOR: 3RD FLOOR f llinglaCC6SS) <br /> 2,352.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available O tions. <br /> (Please round to nearest dollar) —P —°' $ 80,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes ONo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes 4No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes 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 ONo ❑Don't know <br /> 7. Is this to correct a violation? nYes IgNo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ -* -P <br /> 545-112(4/08) <br />