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w <br /> �IG P�VIT' P 'CA11ON w�aia�n SUPPLEMENT to Web App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> John Peterson ______ 0 Zoning Status;CUP; <br /> O"ER ADDRESS (Number,Street,Qty,Slate.Zip) Deed Restriction;CSM <br /> 1789 Bringold DR,Verona,WI,53593 Variance(it ) <br /> t$ P -E 079 LEQ L-3(2 7a E-MAIL ADDRESS <br /> .ohn ••terson7l @•mail.com D Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Tri-State Carports _ ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of Well/septic <br /> 336 River End Land <br /> (Qty.Stats Zip) (aty,Slate.Zip) D Setbacks <br /> Mount Airy, NC,27030 <br /> PHONEp E D Site Plan approval from <br /> W71)71) y qv —21'l 1 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> sales@tristatecarports.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (hl tp:Uaccessdane.co.dane.wi.usl) DElevationofprOperty <br /> PARENT PARCEL NUMBER CURRENT ZONING ACREAGE <br /> ❑PARCEL 0607-352-9564-0 RR-4 5.295 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP, SECTION <br /> Springdale 35 _ 1/4: SE 14: NW ❑Driveway permits <br /> RDDRESS (state,county,town) <br /> 1789 Bringold DR <br /> M LOTSUBDIVISION BLOCKILOT <br /> 8218 4 ❑sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION <br /> storage shed 20' X 25' VZoning District <br /> . QThis project is a new building or structure. Nil Permitted Use?YES, R.A.B. <br /> DThis project is an addition/alteration to an existing building or structure_ <br /> SANITARY SERVICE PERMIT NUMBER 4 Rural Address EX <br /> FIE WER InEPTIC (new/existing) <br /> HEIGHT IN FEET. NUMBER OF STORIES. (Net including basement) N O <br /> 13.25 MEAN 14.5 1 VWetland/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 Q'ErosionControl permit <br /> 500 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, N O <br /> filling/access) <br /> 2ND FLOOR 3RD FLOOR <br /> 500 J Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -+ -► -i -► -► and available options. NO <br /> (Please round to nearest dollar) $ 11944 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ✓E o DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Des ✓ o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dyes Dio <br /> 5. Is this project associated with a rezone,CUPlvariance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dyes [ o []Don't know <br /> 7. Is this to correct a violation? Dyes ✓J o <br /> TOWN APPROVED 12' HEIGHT, NOT 14.5' APPUCA11ON MUST BE SIGNED <br /> (Continue on Back) —* -i —0. <br /> REV(01/15 <br /> FEE = $100 <br />