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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 /> Adam & Jennifer Wendorf Zoning Status; CUP; <br /> 4 OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2817 Spring Hill Dr. Stoughton, WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)873-0840 (608)279-1211 adam @wendorfconstruction.com (i Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION ``f�i'''and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Wendorf Construction and Remodeling N Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 2817 Spring Hill Dr <br /> (City,State,Zip) (City,State,Zip) ®Setbacks <br /> Stoughton, WI 53589 <br /> PHONE PHONE qi Site Plan approval from <br /> (608) 279-1211 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> adam @wendorfconstruction.com NI 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 046/0611-271-8215-3 A1(EX)-RH2 4.58 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Pleasant Springs 27 -/: T6N 1/41/4: R11 E 1:5J Driveway permits <br /> ADDRESS: (state,county,town) <br /> CSM: LOT SUBDIVISION BLOCK/LOT Sanitary permits <br /> 8,082 1 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIE <br /> PROJECT DESCRIPTION: /.� <br /> New Single Family Home '' Zoning District / / <br /> . 0 This project is a new building or structure. Permitted ser? �� " <br /> QThis project is an addition/alteration to an existing building or structure. '1" <br /> SANITARY SERVICE: PERMIT NUMBER: Al - - 'ddress <br /> EWER J EPTIC 13,201 ,600,252 dr xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) > 300 <br /> 21.0 1.0 ALWet ..• loodplain/ <br /> 41a1= (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside diruqnsipnf cduding unfinished are c e garages and above grade decks or porches) A-�( r <br /> BASEMENT: / 1ST FLOOR: 9€ErosionControl permit C <br /> / .0 j TOTALT RE FOO AGE: j (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: / filling/access) © �6, <br /> 0343 <br /> ' Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ ,/� and available options. <br /> (Please round to nearest dollar) © �V�I CO <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? :Yes ✓No LjDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYesO ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q✓Yeso <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes Jo <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) Q✓Yes ao Don't know <br /> 7. Is this to correct a violation? r--- ❑Yes D10 <br /> (1 q '--1 1 5 APPLICATION MUST BE SIGNED <br /> Continue on Back) --t• -+ <br /> 545-112(4r08) ( )g3 / , 32‘C <br />,,„. <br />