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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Joseph Pertzborn n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2139 County Rd PB Verona,Wi 53593 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)848-9549 (608)575-1504 jpertzborn@hjpertzborn.com Ili Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp Ti Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli S.t <br /> (City,State,Zip) (City,State,Zip) ❑✓ Setbacks <br /> Verona,WI <br /> PHONE PHONE n Site Plan approval from <br /> (608) 845-9700 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL 062/0608-262-8380-01 RR-2 5.10 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION:• ``( P•.. ;` N 1'- Driveway permits <br /> Town of Verona 2,6gg' 1/4: -"NE` . t/4: • NW <br /> ADDRESS: (state,county,town) <br /> 2139 County Rd. PB i/ _ <br /> H Sanitary permits = <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 2,499 3 (public;private) y i /i <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: ) ` / I 1 <br /> 32 x 36 pole building addition to an existing pole building (4' , i(c/" 1.4---:;J? - 1 t ❑ Zoning District <br /> EThis project is a new building or structure. <br /> Permitted Use? <br /> nThis project is an addition/alteration to an existing building or structure, <br /> SANITARY SERVICE: PERMIT NUMBER: / ; <br /> ❑ Rural Address <br /> EWERpEPTIC !f (new/existing) i <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> LIWetland/Floodplain/ <br /> t.. Shoreland (attachment-7 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> a,tsEtvrFar' ; 1ST FLOOR: ❑ ErosionControl permit <br /> Lt _ -1_ ,,Z 1 ,152.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> �` filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 1 1 52.0 <br /> V i tv\ ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: .- ♦ ♦ ♦ ♦ ♦ $ 18 000.00 and available options. i \,i� <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 4- / lo Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes Iv INo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ✓UYes nNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ElYes ✓❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leavL.,e blank if none) <br /> 6. Is a location survey required? (see reverse) Res nNo fDon't know <br /> 7. Is this to correct a violation? es �✓ No <br /> ao 11 -, cog !. ?. r APPLICATION MUST BE SIGNED <br /> C �/i 1I (Continue on Back) - .- -i <br /> 545-112(4/08) � 1 �� <br />