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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App I <br /> PROPERTY OWNER INFORMATION CUfTOMER TO PROVIDE <br /> OWNER NAME Ryan Malmgren and Stacey Rieu <br /> OWNER ADDRESS (Number,Street,City,State,Zip) [ DondRestriction;CSM <br /> Zoning Status;CUP; <br /> 2279 Dahlk Circle, Verona, WI 53593 Variance <br /> vaance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-225-4287 781-366-2397 staceyrieu@gmail.com LMS)te Plan drawn to scale <br /> AGENT INFORMATION ! CONTRACTOR INFORMATION hdincludes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ClearyBuildingCorp <br /> P �' a Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 190 Paoli Street <br /> (City,State,Zip) (City,State,Zip) EIS,backs <br /> Verona, WI 53593 <br /> PHONE PHONE 608-845-9700 Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> msonday@clearybuilding.com loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ®Elevation of property <br /> PARENT PARCEL NUMBER: CURRENTZONING: ACREAGE: <br /> D PARCEL 054/0607-243-9622-1 RR-4 5.461 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Springdale 24 1/4: SW t/4: SE ❑Driveway permits <br /> (state,count town) <br /> \ <br /> ADDRESS. 2279 Dahlk Circle, Verona, WI 53593 j <br /> ❑Sanitary permits / <br /> CSM. 07784 LOT 2 SUBDIVISION BLOCK/LOT iiubhp;'private) / JI <br /> PROPOSED PROJECT INFORMATIONTAFF REVIEW ti's';/ <br /> 1 <br /> PROJECT DESCRIPTION: — / �� <br /> Accessory building/workshop ) 'X' 3i / oning District <br /> . ❑✓This project is a new building or structure. ll Permitted Use? I <br /> ❑This project is an additionteration to an existing building or stru turc. C i �/ <br /> SANITARYSERVICE PERMIT NUMBER: U Rural Ad li I <br /> EWER PEPTIC 1'� (new/e (sting) _5-. <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not inclu i g basement) <br /> 16 1 ❑ Wetland/FI ain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attachedgarages and above grade decks or porches) <br /> BASEMENT: 7ST FL O , ❑ ErosionControl.permit <br /> 30 x 56' 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> q' filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 1 680 <br /> ❑ Review Location Survey ESTIMATED CONSTRUCTION COST -+ .- ♦ -6. $ 52,598 and available options. 7\DQ) <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? Dies ✓'lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [fres ENO ['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) [fres Elio ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ❑✓No <br /> APPLICATION MUST BE SIGNED <br /> s'it (....7\ g ,_ <br /> REV(01/15) / <br /> (Continue on Back) —► ♦ <br />