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ZONING PERMIT APPLICATION www.countyofdane.colll SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Norbert Repka <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Zoning Status; CUP; <br /> Deed Restriction; CSM <br /> 2014 Manhattan Dr.,Verona,WI 53593 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)213-0401 norbert_repka @hotmail.com 15I Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Norbert Repka <br /> Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2014 Manhattan Dr. <br /> (City,State,Zip) (City,State,Zip) IS Setbacks <br /> Verona,WI 53719 <br /> PHONE PHONE 0 Site Plan approval from <br /> (608) 213-0401 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> norbert_repka @hotmail.com 151 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:I/aeeessdane.eo.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ig <br /> ❑PARCEL 0608-284-8440-2 RH-2 6.21 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Verona '/: WA: 0 Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2014 Manhattan Dr. <br /> CSM: 5 947 LOT 2 SUBDIVISION BLOCK/LOT 0 Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Carriage House ❑ Zoning District <br /> OThis 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 [EPTIC 13,201 ,700,155 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 26.7 2.0 ❑ 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 /> 3i,"1, 1A-7-&:0 Zos 4, TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: "L �1 <br /> filling/access) <br /> /62,,, 11a ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ODO and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ $-9 00,000.0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes EINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 1%1 No <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) Lives PANo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />