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ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION AIM, - - CUSTOMER TO PROVIDE <br /> OWNER NAME ROBERT L CARLSON <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City.State,Zip) Deed Restriction: CSM <br /> 5498 COUNTY HIGHWAY CV MADISON WI 53704 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)513-1636 ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli St <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Verona,WI <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 379-0132 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tleeser@clearybuilding.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wl.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 014/0810-191-8800-9 HC 1.32 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION <br /> Town of Burke 19 /4: NW %IA: NE ❑ Driveway permits <br /> ADDRESS: (state, county,town) <br /> 5492 COUNTY HIGHWAY CV <br /> n Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION =Mk STAFF REVIEW <br /> PROJECT DESCRIPTION: 80' X 22' <br /> 1760 sq ft open lean off existing building for camper storage ❑ Zoning District <br /> nThis project is a new building or structure. ❑ Permitted Use? YES <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address EX <br /> TS EWER 1EPTIC (new/existing) <br /> HEIGHT IN FEET: 1 O 1.0 ❑ <br /> NUMBER OF STORIES: (Not including basement) <br /> 16.7 MEANWetland/Floodplain/ NC <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT 1ST FLOOR: ❑ ErosionControl permit <br /> 4 TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance,NO <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 1,760.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. NO <br /> (Please round to nearest dollar) -- ♦ ♦ ♦ ♦ — $ 50,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ❑✓No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ENo ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dyes TINo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 0No <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 QNo ❑Don't know <br /> 7. Is this to correct a violation? Dies 0No <br /> $350.00 <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) — —► -s- <br /> 545-112(4/08) <br />