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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Martin and Peggy Gochnour 0Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,Stale,Zip) Deed Restriction;CSM <br /> 3131 Woods Rd., Verona, WI 53593 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 832-764-9935 832-764-9935 • •ochnour0115@•maii.com [J Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Brandon Sheiliam ElSite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 309 S. Washington S. <br /> (City,State.Zip) (City,State,Zip) 0 Setbacks <br /> VERONA Cuba City, WI 53807 0 Site Plan approval from <br /> PHONE PHONE 608-732-2260 <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS Floor plans to scale <br /> randonsheliam16@gmail.cor ri <br /> PROPERTY/LOCATION INFORMATION (http.//a ccessdane.co.dane.w$.us/) Q Elevation of property <br /> PARENT PARCEL NUMBER CURRENT ZONING'. ,l ACREAGE: frontage drawn to scale. <br /> ❑NPARCEL UMBER 0608-0429671-0 .1-i;,Q ) 5 acres S <br /> TOWNSHIP SECTION: h l\,r Kw 0 Driveway permits <br /> Verona 4 '�4 1�4 (state,county,town) <br /> ADDRESS 3131 Woods Rd. Verona, WI 5359 El <br /> %. <br /> CSM I"T.. <br /> 296 r1i)-SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION ;STAFF REVIEW <br /> PROJECT DESCRIPTION i <br /> Removing old Deck off of master bedroom west facing and d Zoning District <br /> nThis 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: j ❑ Rural Address') <br /> EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES _(Not including basement) <br /> 2 ft. ( CIWetland/Floodplain/ <br /> _ -- -- -- Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) U ErosionControl permit <br /> BASEMENT: 1ST FLOOR 780- f TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> . i ri,4, - filling/access) <br /> 2ND FLOOR: 3RD FLOOR <br /> }� ?‘‹Z; <br /> 1 <br /> z ❑ Review Location Survey "N., <br /> ESTIMATED CONSTRUCTION COST: and available options. \j <br /> -► <br /> (Please round to nearest dollar) -+ -+ -♦ -► -► 25,000.00 <br /> F' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? DYes In f Le Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYeso,✓Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q✓Yes o' <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ]Yes QNo / <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 0Don't know <br /> 7. Is this to correct a violation? v Dies Elio <br /> s <br /> / 'S ;P.. APPLICATION MUST BE SIGNED <br /> �.y,� , (Continue on Back) --o -i -4- <br /> REV(01/19) x ��.�_= s <br />