Laserfiche WebLink
ZONING PERMIT APPLICATION www.countyofdane.com 10=37 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> John Ringstad <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Cl Zoning Status; CUP; -r/ . <br /> eed Restriction; CSM <br /> 3749 Old Stone Rd <br /> Variance(# ) <br /> HOME PHONE 1 CELL PHONE E-MAIL ADDRESS <br /> (608)469-5350 (608)469-5350 john.ringstad @gmail.com N Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions /©G <br /> AGENT NAME CONTRACTOR NAME <br /> lb H� . -kl.aCFS Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 3714/ OA s'77)13f Rb <br /> (City,State,Zi)) (City,State,Zip) ❑Setbacks <br /> Oregon Q(Z)r{0 <br /> PHONE PHONE ❑Site Plan approval from <br /> (..ea K G l — 53 applicable township. <br /> E-MAIL ADD R ES E-MAIL ADDRESS <br /> 5olnh,ri n ‹- e ma"./ • co, ,,'Floor plans to scale /�it <br /> PROPERTY4LOCATION INFORMATION (http://accessdane.co.dane.wLus/) Elevation of property / <br /> PAREN- PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCE. oy� p 7 A V� 4-i 1 frontage drawn to scale. <br /> NUMBER �'7�S�C�''Z�� l�D�d ! J-t I �(�l o� <br /> TOWNSHIP: SE, I <br /> 21)-rL,4/JD G ' 1/4. S %/4I/4. SF vi_Driveway permits <br /> RESS: (state,county, alb <br /> A <br /> I7ti' oLD 5'TD ) 1Z4 <br /> CSM: LOT SUBDIV SION BLOCK/LOT unitary • u Its <br /> i _ <br /> (public,aial <br /> I PROPOSED PROJECT INFORMATION / STAFF REVIEW <br /> PROJECT DES 0-IPTION: _/ .-/ <br /> c7Vt-S 1De T'E' 2 C x 2I QA a< 3 iZoning District <br /> . grThis project is a new building or structure. aP Use? © e..........e..........ermitted Use / C c-1C <br /> ❑This project is an addition/alteration to an existing building or structure. /� <br /> SANITARY SERN,ICE: PERMIT NUMBER: 2FRuralAddress It <br /> DEVVER MEPTIC (new !sting S r <br /> HEIGHT IN FEET. NUMBER OF STORIES: (Not including basement) <br /> Z — 3 .1 4.0 loodplain/ <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: n kErosionControl permit O <br /> 51 V 0 4, TOTAL SQUARE FOOTAGE: 4, (slopes, disturbance, A�/p2 <br /> filling/access) , <br /> 2ND FLOOR: 3RD FLOOR: / d O <br /> Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ O d and available options. <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? ['Yes No fDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Dies EINo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Des 13 No <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) [Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) <br /> 545.112(4/08) <br /> i <br />