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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 /> Rodney Sheldon 2/Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 962 FLint Rd Stoughton,WI 53 Variance(# NVAt ) <br /> HOME PHONE LL_NINE -- E-MAIL ADDRESS <br /> (608)877-0763 (608)208-0500 r.sheldon @stategroup.com Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Buildings []Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wellseptic <br /> po Box 930220 <br /> (City,State,Zip) (City,State,Zip) [etbacks <br /> Verona,WI 53593-0220 <br /> PHONE PHONE dSite Plan approval from <br /> (608) 845-9700 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> mailto:dzeal @clearybuilding.com []Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ErElevation of property <br /> ❑PARCEL 052/0510-162-9503-0 A_1 r 23.12 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> • Rutland 16 1/4: SE 1/41/4: NW d r eway permits <br /> ADDRESS: (state,county,town) <br /> 962 Flint Rd <br /> EfCSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION TAFF REVIEW <br /> PROJECT DESCRIPTION: g Q="b �� g Addition onto our existin horse arena. • •o in District <br /> . ❑This project is a new building or structure. ❑ rmitte s <br /> 4This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: k) ❑ Rural ddress <br /> EWER [EPTIC (new/e ' ti <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 21.8 1.0 ❑ Wetland oodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shor nd (a chment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 1-1 ErosionC trot permit <br /> BASEMENT: 1ST FLOOR: ci (J <br /> �,e"1 4, TOTAL SQUARE FOOTAGE: 4, (slopes isturbance, <br /> 2ND FLOOR: 3RD FLOOR: fillln CCESS) (R <br /> L3 Review Location Survey' <br /> ESTIMATED CONSTRUCTION COST: and available Options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ —, —0' -♦ $ 30,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓Nlo DDon't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑✓Yes ao ❑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? QYes ❑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) Eyes Oslo ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓Nlo <br /> 7TAPPLICATION MUST BE SIGNED <br /> -/ (Continue on Back) ■ -+ -* <br /> 545-112(4/08) <br />