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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Douglas & Linda Larsson ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State.Zip) Deed Restriction; CSM <br /> 2041 Skyline Drive - Stoughton - WI - 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-205-6202 847-514-7303 douglarsson @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> same as owner same as owner ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City.State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) I=1 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE <br /> ❑PARCEL 046-0611-292-4237-0 R-3 .332 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> pleasant springs TO6NR11 E 29 1/4: SW 6 1/41/4: NW b` ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> 2041 Skyline Dr- Stoughton - WI - 53589 <br /> CSM: LOT SUBDIVISION I BLOCK/LOT ['Sanitary permits <br /> 12754 1 KEGONSA GRV I (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Replace front porch (deck and cover) O Zoning District <br /> . ❑This project is a new building or structure. 0 Permitted Use? <br /> 171This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Q Rural Address <br /> EWER E)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES (Not including basement) <br /> 24 2 Q 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 1ST FLOOR l 0 ErosionControl permit <br /> 45 192 /�� 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> CCVV//'" <br /> filling/access) <br /> cess) <br /> 2ND FLOOR: 3RD FLOOR: . /^� <br /> 350 6 <br /> t�.I Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: —°' ♦ ♦ ♦ ♦ S and available options. <br /> -+(Please round to nearest dollar) S 3,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ZYes ❑No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes ❑No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? gYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ❑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 ENO ['Don't know <br /> 7. Is this to correct a violation? ❑Yes IZINo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -♦ <br /> 545-112 14/081 <br />