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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 <br /> Steve and Kelly Lagman <br /> El Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2589 Lalor Rd,Oregon,WI,53575 Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (608)212-0104 steve.lagman @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Aldo Partners, LLC ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2993 Kapec Rd <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Fitchburg,WI 53719 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 209-2183 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> andyf @aldopartners.com ❑ 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 /> ❑PARCEL 028/0610-182-8500-7 Al -EX 38.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunn 18 '/4: %V4: ❑Driveway permits <br /> ADDRESS: (state, county, town) <br /> 2589 Lalor Rd, Oregon, Wi 53575 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Single Family Residence ❑ Zoning District <br /> . Fl This project is a new building or structure. <br /> Li Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ Rural Address <br /> FIEVVER 1EPTIC (new/existing) <br /> HEIGHT IN FEET Z f NUMBER OF STORIES: (Not including basement) <br /> g 2.0 ❑ Wetland/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 ,L" 1ST FLOOR: ❑ ErosionControl permit <br /> ) o Y 7 3.84110 l/3 Z , j TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: r <br /> filling/access) <br /> I / 6 8 6,6. Z ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: -+ -+ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ (5O, bDG.oo <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'? ['Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [tes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank pone) <br /> 6. Is a location survey required? (see reverse) ['Yes I N ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes 2No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► ■ -► <br /> 545-112(4/08) <br />