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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION <br /> OWNER NAME CUSTOMER TO PROVIDE <br /> Scott and Tracy Bellefeuille <br /> OWNER ADDRESS (Number,Street,City,State,Zip) ❑Zoning Status; CUP; <br /> 701 Larvik Lane, Stoughton WI 53562 Deed Restriction; CSM <br /> Variance(# ) <br /> HOME PHONE CELL PHONE <br /> E-MAIL ADDRESS <br /> (608) 513-3908 scottybelle25 @gmail.com <br /> ❑Site Plan drawn to scale <br /> AGENT INFORMATION <br /> CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Hart DeNoble Builders Hart DeNoble Builders <br /> Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 7923 Airport Rd 7923 Airport Rd <br /> (City,State,Zip) (City,State,Zip) El Setbacks <br /> Middleton, WI 53562 Middleton, WI 53562 <br /> PHONE PHONE El Site Plan approval from <br /> (608) 831-4422 (608) 831-4422 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> bnorth @denoblebuilders.corn Q Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn <br /> ElPARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Q Elevation of property <br /> PARCEL <br /> NUMBER 06 //-3/2 .- 20 YZ. 0 Res 00 frontage drawn to scale. <br /> •TOWNSHIP: SECTION: <br /> Pleasant Springs 3 f I/4: ,/,/4: El Driveway permits <br /> ADDRESS: (state, county,town) <br /> 30 69 Li rn r1 a r,04 1'r- <br /> CSM: LOT 2 SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> EST-ATV- <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: STAFF REVIEW <br /> New Single Family Res ❑ Zoning District <br /> MI This project is a new building or structure. <br /> ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> 61-7EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 26.0 ❑ Wetland/F000dplain/ <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 /> 2,484.0 �S�y + TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 1 ,430.0 6,744.0 <br /> ESTIMATED CONSTRUCTION COST: ❑ Review Location Survey <br /> (Please round to nearest dollar) ♦ .- -' ♦ -+ ♦ $ 330,000.00 and available options. <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ]No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ao ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ,Yes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Dies ON <br /> 5. Is this project associated with a rezone/CUP/variance (petition/appeal# 6h8 Lt., (leave blank if none) <br /> 6. Is a location survey required? (see reverse) Dies 0. QDon't know <br /> 7. Is this to correct a violation? QYes /OW <br /> APPLICATION MUST BE SIGNED <br /> 545-112 ra;oel (Continue on Back) - -► -+ <br />