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. $ i \ -3 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Dan France Oning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1703 County HWY W Stoughton,Wi 53589 Variance(# cl M$r ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)219-8839 I ‘Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic , <br /> 190 Paoli St <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> Verona,WI .---" <br /> PHONE PHONE ;❑Site Plan approval from //� <br /> (608) 379-0132 applicable township. f-r <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tleeser @clearybuilding.com OOr plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) evatlon of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p rty <br /> ❑PARCEL 016/0612-314-8020-0 RH-1 2.39 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: 5' 1-1t- <br /> Town �I <br /> of Christiana 31 +/4: 1/41/4: ' tat p,county,permits t � <br /> ADDRESS: 7/.. <br /> (stat ,county,town) <br /> 1703 County HWY W Stoughton, WI Sanitary permits <br /> CSM. 11 428 LOT 1 SUBDIVISION BLOCK/LOT (p ublic,private) '� <br /> PROPOSED PROJECT INFORMATION `° }} <br /> � • Y E_ K <br /> 1 <br /> PROJECT DESCRIPTION: . <br /> 21x40 Storage shed -.,- <br /> 0 This project is a new building or structure. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> EWER [)EPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 16.0 1.0 ". a <br /> R <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) < 0 <br /> BASEMENT: 1ST FLOOR: <br /> (%L) , TOTAL SQUARE FOOTAGE: 1 <br /> 2ND FLOOR: 3RD FLOOR: l, r v <br /> 840.0 /0 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ —' ♦ ♦ $ s :: <br /> (Please round to nearest dollar) $ 1 2,000.00 — -C1• <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑✓No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Ekes allo ❑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? Oyes ✓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) Ekes ■lo ❑Don't know <br /> 7. Is this to correct a violation? [Yes EN <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —o —► <br /> 545-112(4/08) <br />