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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Good Shepherd By The Lake Lutheran Church c.,-P• t2ac. S i 5 <br /> 0 Zoning Status; CUP; u`sos <br /> O S u ber,stye t,Ci State,Zi > Deed Restriction; CSM <br /> 1 � 5. iilg�iway 1,t'Stougiiton, WI 53589 Variance Restriction; ) <br /> HO H NE CELL PHONE E-MAIL ADDRESS e.-44-3 <br /> - 73-5924 gsoffice @tds.net ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> PHONE 5-2,44004.-- PHONE ❑Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: Otylt7-- CURRENTZONING: ACREAGE: 0 Elevation of property <br /> 0PUMBER '25 3 9000 -- 4 2N-3 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Dunn 2 s Y4: IRA: ❑Driveway permits <br /> ADDRESS (state,county,town) <br /> 1860 U.S. Highway 51, Stoughton, WI 53589 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> P OJ CT SCRIPTION: <br /> Add steeple to existing church building ZrZoning District <br /> . OThis project is a new building or structure. <br /> permitted Use? <br /> Ei This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: Rural Address <br /> EWER IEPTIC (new/existing) <br /> HEIGHT IN FEET: r NUMBER OF STORIES: ( t including basement) <br /> re- - 3 One 14 Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ErosionControl permit <br /> l TOTAL SQUARE FOOTAGE: j / (slopes,disturbance, <br /> pat>q 'J(A. filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> ' (A Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) I. 1 C'a70 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Liles aro EiDon't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes ,/No DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Isles _No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Yes "lo <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) Ekes ,/No DJon't know <br /> 7. Is this to correct a violation? ❑Yes ./No <br /> 4 ..2Sete APPLICATION MUST BE SIGNED <br /> 545-112(4ro8) <br /> r (Continue on Back) ■ ■ —► <br />