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,. /.-) „--, 1 <br /> 65 l c <br /> i <br /> SUPPLEMENT to Web-App # <br /> ZONING PERMlibig&CATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Ken & Rachel Miller ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City,State.Zip) Deed Restriction; CSM <br /> 2464 Sanford Road,Stoughton,WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)698-0833 (608)698-0017 madhocky99 @yahoo.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden-Meigs Inc. Meigs Inc. ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1527 Hwy 14,P.O.Box 412 1527 Hwy 14,P.O.Box 412 <br /> (City,State,Zip) (City.State,Zip) ❑Setbacks <br /> Black Earth,WI 53515 Black Earth,WI 53515 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 767-2729 (608) 767-2729 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com dave @meigsbuilds.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) El Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> 0 PARCEL 046/0611-153-8020-1 A-2 20.00 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Pleasant Springs 15 1/4: NW /4%/4: SE ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 2464 Sanford Rd, Stoughton, WI 53589 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> . r4This project is a new building or structure. ❑ Permitted Use? <br /> Elms 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 /> 26.5 1.0 LI VHetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ ErosionControl permit <br /> BASEMENT 1ST FLOOR: <br /> 12,450.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 12,450.0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ Q� +Z�� and available options. <br /> (Please round to nearest dollar) �P J (� <br /> 1 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes '4No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? Eyes I2No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ['Yes '4No <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 JNo ❑Don't know <br /> 7. Is this to correct a violation? Eyes IN No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ — –► <br /> 545-112(4218) <br />