Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Anniversary Dream Estates, LLC. <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3987 Barlow Road,Cross Plains,WI,53528 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)798-3151 (608)225-9191 herrling@chorus.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Nick Urumoglu Cleary Building Corp 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli Street 190 Paoli Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Verona,WI,53593 Verona,WI,53593 <br /> PHONE PHONE ❑Site Pla a lfrom <br /> (608) 577-8950 (608) 845-9700 applic I n hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS n <br /> nurumoglu@clearybuilding.com nurumoglu@clearybuilding.com ❑ Floor plans to scale 1 <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: p p y <br /> Ti PARCEL 070611180013 Fp-35 34.10 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Vermont 11 1/4: NE %1/4: NE ❑Driveway permits <br /> ADDRESS: (state, county,town)� <br /> 4518 WI 78, Black Earth, WI, 53515 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits ""l J <br /> (public,private) Jtjd.rA+� <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Construction-Replacement Residence Single Family Dwelling ❑ Zoning District <br /> . ❑✓ 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: ❑ Rural Address <br /> EWER 1EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 19.0 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 /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> 3,180.0 + TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, <br /> ' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3,180.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: - ♦ - ♦ and available options. <br /> ♦ ♦ <br /> (Please round to nearest dollar) $ 292,317.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Des ❑No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑✓Yes ❑No ['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? ❑Yes ❑✓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) ['Yes No ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -i -♦ <br /> 545-112(4/08) <br />