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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 /> Ronald Schultz ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> Deed Restriction; CSM <br /> 2625 Fitchrona Road,Verona,WI 53593 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)848-5432 (608)217-8928 Rschultz10s @charter.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi-us/) ❑Elevation of property <br /> PARENT PARCEL NU BER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL ( a (3 f9 R6 0 , Residential/D`l 1.88 frontage drawn to scale. <br /> NUMBER ((jj��-- <br /> TOWNSHIP: SECTION <br /> Town of Verona /a: 1/1/4: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 2625 Fitchrona Road <br /> CSM: 6 981 LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Construct 12'x16"DIY Shed ❑ Zoning District <br /> . Ig 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 ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES' (Not including basement) <br /> 12.0 1.0 LI Wetland/Floodplain! <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: Q ErosionControl permit <br /> 192.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 192.0 D Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -10. ♦ ♦ ♦ -0. $ 5 000 00 and available options. <br /> (Please round to nearest dollar) , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes rdNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres ONo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes ENo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies ONo <br /> 5. Is this project associated with a rezoneiCUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Efres '4No ❑Don't know <br /> 7. Is this to correct a violation? Efres '4No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i <br /> 545-112(4/08) <br />