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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION Cu-TOMER TO PROVIDE <br /> OWNER NAME <br /> Rollin & Helen Rucks <br /> Ei <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Z Wing Status; CUP; <br /> eed Restriction; CSM <br /> 2549 S Hill Street,Stoughton,WI,53589 <br /> ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)873-9377 (608)338-9377 rcrucks @live.com ite Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> see owner information CR Construction(Cliff Rucks) ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS f well/septic <br /> 1557 Burve Road <br /> (City,State,Zip) (City,State,Zip) Setbacks <br /> Deerfield,WI,53531 <br /> PHONE PHONE ❑ ite Plan a oval from <br /> (608) 358-0539 ap licab township. <br /> E-MAILADDRESS E-MAIL ADDRESS <br /> oor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING:- ACREAGE: P p y <br /> pg NUMBER <br /> 0611-161-9840-7 Al I : ?( 7.00 frontage drawn to scale. <br /> TOWNSHIP: SECTION: (` <br /> Pleasant Springs 16 1/4: 1/a1/a: ❑ Driveway rmits <br /> ADDRESS: (state, Unty,town) <br /> 2549 S Hill Street, Stoughton, WI, 53589 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary rmits <br /> pub. , private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Add three season Porch 41. ®oiling District <br /> . ❑This project is a new building or structure. <br /> Permitted e? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ® Rural . ®• - <br /> [EWER rEPTIC (new/e stins, <br /> HEIGHT IN FEET , OF STORIES (Not including basement) <br /> /0 , 24-:5� -2-0- ❑ iNetlan oodplaln! <br /> Sh <br /> ( AREA TO NEAREST SQUARE FOOT: nd (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> Li �tQ <br /> BASEMENT: - �� 1ST FLOOR:a,14oa (� 4, TOTAL SQUARE FOOTAGE: ,, lope isturbance, <br /> 7p 1) <br /> !ling cress) <br /> 2ND FLOOR 3RD FLOOR: 0.0 _1 1 50.0 <br /> (�' J\ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and available options. 6 <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ 10,000.00 <br /> p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes '4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Efres E INo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes 4No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies ❑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) Elves ONo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> Asci APPLICATION MUST BE SIGNED <br /> i (Continue on Back) ♦ ♦ -+ <br /> 545-112(4/0e) <br />