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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 /> Chris Goggin ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2923 McConnell Rd Stoughton,WI Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)669-3148 armyboy87 @hotmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli St <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Verona,WI <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 379-0132 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tleeser @clearybuilding.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 046/0611-071-8025-5 A-1 Ex 1.17 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Pleasant Springs 7 1/4: NE 1/41/4: NE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2923 McConnell Rd <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAF <br /> PROJECT DESCRIPTION: ` 4--in <br /> 18x27 Storage shed ❑ Zoning 1 ct z+ <br /> . 0 This project is a new building or structure. <br /> ,- Permitted Use? ,_ <br /> 9This project is an addition/alteration to an existing building or structure. ; _; <br /> SANITARY SERVICE: PERMIT NUMBER: Li, RuralAddre <br /> EWER [EPTIC (new/existing)4 <br /> HEIGHT IN FEET: NUMBER OF STORIES. (Not including basement) <br /> 12.5 1.0 ❑ Wetland/l food lai rf -, <br /> Stioreland°'(attactirrient) °= <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) r <br /> BASEMENT 1ST FLOOR: <br /> ❑ EroslonContral permit rry , <br /> 1 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 486.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: and,available 4 tions. <br /> (Please round to nearest dollar) '♦ -+ -► -► ♦ $ 20,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes FNo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes ENo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? ❑Yes 4No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? f Yes rNo <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) ❑Yes 4No [1]Don't know <br /> 7. Is this to correct a violation? ❑Yes ONo <br /> APPLICATION MUST BE SIGNED <br /> sas-itz(4/08) (Continue on Back) -► -+ -* <br />