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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jason F Penn ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3092 Timber Lane, Verona,WI 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 239-0415 jason @trunk.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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 Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Verona,WI 53593 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 845-7070 applicable township. <br /> E-MAIL ADDRESS E-MAILADDRESS <br /> JGunders @clearybuilding.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=I Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL 062/0608-061-9240-1 R-1 2.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Verona 6 '/4: SW '/%: NE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 3092 Timber Lane <br /> CSM. 14 549 LOT 1 SUBDIVISION BLOCK/LOT El,549 permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Storage Shed ❑ Zoning District <br /> . cs This project is a new building or structure. ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER F/EPTIC �--' (new/existing) <br /> HEIGHT IN FEET � NUMBER OF STORIES: (Not including basement) <br /> 11 .5 1.0 ❑ 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: ❑ ErosionControl permit <br /> 1,200.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1 ,200.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. <br /> (Please round to nearest dollar) ♦ • —► ♦ • ♦ $28,500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes EINo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ✓ Jo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#_0_61_523) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes ✓INo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓IJo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ♦ -► <br /> 545-112(4/08) <br />