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FIr+R, <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Tyson Tran <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 7538 Fallen Oak Drive,Verona,Wisconsin, 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 6084699467 tyson1 @tds.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Advanced Building Corporation ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3624 Pioneer Road <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Verona,Wisconsin, 53593 <br /> PHONE PHONE ❑Site Plan approval from <br /> 608-833-0900 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ilindert@advbldgcorp.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 1=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL A_) frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> 1-Ni 1 C n t5-70 N '/a: WA: ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Sunroom and deck addition 1 Zoning District <br /> . ❑This project is a new building or structure. <br /> Permitted Use? <br /> 1g This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Q RuralA <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3 II/Vetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionCOntrol permit <br /> I TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR:650 3RD FLOOR: 650 JReview Location Survey <br /> ( <br /> ESTIMATED CONSTRUCTION COST: ♦ -+ -+-► ♦ '' 125,000 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 ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Elves ONo ❑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? Elves MNo <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) Elves ig No ❑Don't know <br /> 7. Is this to correct a violation? Elves NW <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ -. -+ <br /> 545-112(4/08) <br />