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`2>t ,0-7 t 1 L, C.7 = X26 <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION USTOMER TO PROVIDE <br /> OWNER NAME <br /> Ben Marshall k uhf •' "/t_ ( , CUP• <br /> ✓ Zoni atus; , <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed estriction;CSM <br /> 6050 Perrot Place McFarland,WI 53558 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI .DDRESS <br /> (608)838-7881 (608)225-6805 benhere90 @yahoo.com <br /> Q Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME 'ONTRACTOR NAME <br /> s- contract <br /> Site Plan including location <br /> AGENT ADDRESS CON 'ACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zi. a 0 Setbacks <br /> PHONE PHONE 4 51 Site Plan p V from <br /> applicablti 1 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 4 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.drane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 11 PARCEL 061036186500 RH-1 ?OOI 2.59 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunn 36 1A NE 141/4. NW Driveway er <br /> ADDRESS: (state,co ,town) <br /> . Brooklyn Drive, Stoughton, WI <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits r r.� <br /> 13,720 3 (public,private) }p <br /> PROPOSED PROJECT INFORMATION -STAFF__REVIEW- <br /> PROJECT DESCRIPTION 4 ' -1 <br /> ❑ Zoning District y t; .- <br /> . 0 This project is a new building or structure. ❑ Permitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMB ❑ Rural Address - <br /> FTEWER [EPTIC 19 r l/ (lo 00 R2,...-- (new/existing) <br /> HEIGG TA T i 0 f NUMBER OF STORIES: (Not including basement) . .. <br /> 1.0 ❑ Wetland/Flobdplainl <br /> AREA TO NEAREST SQUARE FOOT: Shoreland_ (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) r;-w <br /> BASEMENT: _ 1ST FLOOR: I <br /> ❑ ErosionControl permit <br /> t Z 06° j TOTAL SQUARE FOOTAGE: j (slopes1 disturbance, +_ <br /> filling/adcosj <br /> 2ND FLOOR: 3RD FLOOR: r <br /> 112046 s _: ; <br /> ❑ RevtewLocation urvey <br /> ESTIMATED CONSTRUCTION COST: and aVailableig Oiii,- ',_` <br /> (Please round to nearest dollar) ♦ ♦ ♦ '♦ Sf aj�10 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? Ores ONo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q✓Yes ONo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes ✓O 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) Oyes �✓No ❑Don't know <br /> 7. Is this to correct a violation? Oyes ✓No <br /> • <br /> APPLICATION MUST BE SIGNED <br /> /Cnnfinun nn 1:1.1.41 J - <br />