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, 4 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Richard Livezey (Z- <br /> OWNER ADDRESS (Number,Street,City,State,Zip) [°�Zoning Status; CUP; <br /> 3928 Trempealeau Trl,Verona WI 53593 Deed Restriction; CSM <br /> HOME PHONE ;CELL PHONE Variance(# ) <br /> E-MAIL ADDRESS <br /> (608)833-2161 (608)692-2161 richardlivezey @outlook.com <br /> Q Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Richard Livezey 'Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3928 Trempealeau Trl <br /> (City,State,Zip) <br /> (City,State,Zip) tg Setbacks <br /> Verona,WI 53593 <br /> PHONE PHONE Site Plan approval from <br /> (608) 692-2161 pplicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> richardlivezey @outlook.com Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: levation of property <br /> ❑PARCEL I 038/0708-192-6371-9 R-1 DCPREZ-0000-02161 0.77 frontage drawn to scale. <br /> NUMBER , <br /> TOWNSHIP: SECTION: <br /> Middleton 19 %: SE 1�41�4. NW BftvewayprTrmtts-- <br /> ADDRESS. 3928 Trempealeau Trl, Verona, WI 53593 (st ry <br /> CSM: LOT 31 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> Prairie Vista (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Outbuilding / � ,r/�_ L( i <br /> �(� X 3 ❑ Zoning District <br /> tg 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: L.1 Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 13.0 1.0 ❑ Wetland/Floodplarn/ <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 /> 480.0 j TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> 480.0 J Cl Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q '� and available options. <br /> $ <br /> (Please round to nearest dollar) ♦ ♦ ♦ '� '� ♦ 7,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dyes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Dyes JNo DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Lives ❑✓No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes Mho <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 QNo ❑Don't know <br /> 7. Is this to correct a violation? [Yes ['No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4108) (Continue on Back) ■ ■ —■ <br />