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ZONING PERMIT APPLICATION www.countyofdane.com =1=7 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Allison James , <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) .-') Deed Restriction; CSM <br /> 7848 Dairy Ridge Rd `I _,re 11 \NJ --.1 "L Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (406)241-7350 akeeffer@gmail.com E],Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION /and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> NA NA Q Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> NA NA <br /> (City,State,Zip) (City,State,Zip) Setbacks / <br /> NA NA <br /> PHONE PHONE ❑site Plan approval from <br /> ppliccbfe township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> NA NA 3.Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ci <br /> ❑PARCEL 062/0608-183-8590-3 RR4 5.16 frontage drawscale. <br /> NUMBER <br /> TOWNSHIP: SECTIOtf> .-� , 1 �` s' <br /> Verona 1/4 1�'u +/4. L ❑ Drivew�ayl5ermits <br /> ADDRESS: 1 (stat9(county own) <br /> 7848 Dairy Ridge Rd, Verona, WI 53593 i) <br /> ❑ Sanitary <br /> CSM: 3275 LOT SUBDIVISION B2LOCK/LOT <br /> ,permits �.. <br /> (publip',", <br /> private) <br /> t �i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: / I <br /> Addition of a new backyard shed 1 X 1 C CZoning District <br /> . IZThis project is a new building or structure. Permitted Use? <br /> This project is an addition/alteration to an existing building or struct re. <br /> SANITARY SERVICE: PERMIT NUMBER: , { <br /> r ❑ Rural Address <br /> EWER iqEPTIC 111/// V (new/ xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (N t including basement) <br /> 8.25 1 ❑ 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 /> BASEMENT: 1ST FLOOR: ❑ ErosionCOntrol permit <br /> 0 167 ,, TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: / <br /> 0 0 167 ❑ Review Location Survey \ \ (1 <br /> ESTIMATED CONSTRUCTION COST: and available options. .-) ) <br /> (Please round to nearest dollar) ' -► --► ♦ ♦ -► $ 3500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes 1211No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes IZINo EDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? s FANO <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es a,o <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) ❑Yes IZINo ❑Don't know <br /> 7. Is this to correct a violation? :Yes 121No <br /> ! G APPLICATION MUST BE SIGNED <br /> çr <br /> � (Continue on Back) -► ♦ -+ <br /> REV(01/19) <br />