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goArefttus C il?c: , F--- <br /> I ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Eric Vieth ❑Zoning Stat s' CUP; <br /> OWNER ADDRESS (Number,Street.City,State,Zip) Deed Restri IOn; CSM <br /> 3430 Quam Drive, Stoughton, WI 53589 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 347-5121 (608) 347-5121 eric.vieth @strand.com IS Site Plan dra n scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes • ensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ed Hefty Construction 0 Site Planeaimg location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s <br /> 1036 Hillcrest Lane <br /> (City,State,Zip) (City,State,Zip) CI Ssks <br /> Oregon WI 53575 <br /> PHONE PHONE Site P oval from <br /> 835-7804 applic b township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS ( � <br /> ed @edhefty.com IM FlooLplans to sc��e ;d Soak( <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) . I ff•�� �'CI td- <br /> PARENT . <br /> PARCEL NUMBER: CURRENT ZONING: ACREAGE: Elevation of pro rty <br /> pg PARCEL 028/0610-253-3262-0 R-3 0.24 frontage dr�rd�n to scale.A llAkta- <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunn 25 1/4: SW 1/41/4: NW is Drivewa •'-!1' . - pi <br /> ADDRESS: (state, ••. own) <br /> 3430 Quam Drive, Stoughton, WI 53589 <br /> CSM: LOT SUBDIVISION BLOCK/LOT 12 Sanity r is //� <br /> 201 ,601 ,306 21 Ole m Park Addition (publi0, pt'fvat ) t+l <br /> OeQua s a 21 <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Boathouse construction ❑ Zoning ©istrict <br /> 12 This project is a new building or structure. ❑ Permitteki Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Addkss <br /> FTEWER [)EPTIC (new/exiOn ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 12.0 1.0 ❑ Wetlan /Floodplain/ <br /> Shorela d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) y��-�' <br /> BASEMENT: i� 1ST FLOOR: —, ErosionCOntrof permit `� <br /> (.{f J� 4, TOTAL SQUARE FOOTAGE: 4, (slopes, d\slturbance, r�(„7 <br /> I"(J filling/acce's) <br /> 2ND FLOOR: 3RD FLOOR: l.J.�� > 7 <br /> "v ❑ Review o : Survey Y` <br /> ESTIMATED CONSTRUCTION COST: -► and a - la,l s o.t ins. <br /> (Please round to nearest dollar) 0 1 000,00 <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 fNo UDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? Q✓Yes No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? E Yes ISNo <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) E Yes QNo ❑Don't know <br /> 7. Is this to correct a violation? QYes isNo <br /> -45b 1-32$ :60 — I17g' 10 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► -► <br /> 545.112(4/08) <br />