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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME VERNON L. STANFLEY <br /> o Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 961 COTTONWOOD DR.,STOUGHTON,WI 53589 Variance(# ) <br /> . HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)877-8449 (608)558-4841 vstanfley @outlook.com 0 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> same as owner 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 0 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/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> ❑PARCEL 0511-172-9501-6 R-1 0.46 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> DUNKIRK 17 /4: SE %/4+/4. NW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 961 COTTONWOOD DR <br /> ❑Sanitary permits <br /> CSM: 6 154 LOT 1 SUBDIVISION BLOCK/LOT (public,private) <br /> RIVERWOOD ESTATES LOT 1 13,0,k <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ACCESSORY BUILDING-STORAGE GARAGE/HOBBY WORKSHOP ❑ Zoning District <br /> r This project is a new building or structure. LI Permitted Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER [EPTIC (new/existing) <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 13.0 1e a 1.0 ❑ 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: <br /> ❑ ErosionControl permit <br /> �{ <br /> n a si. 3 ? ` TOTAL SQUARE FOOTAGE: + (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 616.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 9,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ✓❑•lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ❑No 15I Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes 0No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 'n ❑Yes JNo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# LI 1'3Io) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑✓Yes alo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓}lo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) -► -► -► <br />