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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 /> Steve Janson <br /> ['Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 4615 HWY 73 Deerfield,WI 53531 Variance(# <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 284-0905 ❑Site Plan drawn to scale <br /> AGENT INFORMATION 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 St <br /> (City,State,Zip) (City,State,Zip) n Setbacks <br /> Verona,WI <br /> PHONE PHONE n Site Plan approval from <br /> (608) 379-0132 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tleeser @clearybuilding.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 024/0712-043-8020-0 RH-3 15.30 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: Deli fa- SECTION: <br /> Town of p.,6 44111 ipimgs- 4 1/,. NE 1/41/. SW ❑Driveway permits <br /> ADDRESS: <br /> (state,county,town)montyptiartiontara <br /> 401rwr <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 14,766 1 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 3424 sq ft storage shed ❑ Zoning District <br /> . SI This project is a new building or structure. <br /> ❑ 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 (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 24.7 1.0 ❑ Wetland/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 /> ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> j TOTAL SQUARE FOOTAGE: 1 (slopes, disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3,424.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available o tions. <br /> (Please round to nearest dollar) ♦ $ 100,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? nYes ONo nDon't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes FINo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? nYes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? nYes ONo <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) nYes QNo ❑Don't know <br /> 7. Is this to correct a violation? nYes ONo <br /> APPLICATION MUST BE SIGNED <br /> �{ ���2�.'' (Continue on Back) —r —► <br /> 545-112(4/08) fi �5 <br />