Laserfiche WebLink
µowSC c3 1 .e5 <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Eric Vieth ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 3430 Quam Drive, Stoughton, WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608) 347-5121 (608) 347-5121 eric.vieth @strand.com isi Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ed Hefty Construction Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1036 Hillcrest Lane <br /> (City,State,Zip) (City,State,Zip) 51 Setbacks <br /> Oregon WI 53575 <br /> PHONE PHONE Site Pla a val from <br /> 835-7804 applica hip. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ed @edhefty.com 1M1 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: IN Elevation of property <br /> is PARCEL 028/0610-253-3262-0 R-3 0.24 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunn 25 1/4: SW 1/41/4: NW MI Drive y rmits <br /> ADDRESS: 3430 Quam Drive, Stoughton, WI 53589 (state, nty,town) <br /> Sanitary permits <br /> CSM LOT SUBDIVISION BLOCK/LOT <br /> 201,601 306 21 p <br /> 21 Ole Quams Park Addition 21 (public,private) fb ; <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br />` Residential Home construction ❑ Zoning District <br /> . O This project is a new building or structure. ❑ Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> r • Z�j <br /> 2.0 ❑ Wetland/Floodplain/ <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permltsz 7/- <br /> 962.0 1 989,0 Q /�,l TOTAL SQUARE FOOTAGE: j (slopes,disturbance, •XJ�( <br /> t/ p filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 3� <br /> j [' ❑ Review Location Survey <br /> (STIMAT D CONSTRUCTION)COST: ♦ ♦ ♦ ♦ ♦ ♦ 299,000.00 and available options. <br /> Please round to nearest dollar <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 No ❑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 is <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) ZYes 4#81en ❑Don't know <br /> 7. Is this to correct a violation? ['Yes cs No <br /> p3 .7 3 -= 1 4 330.13 <br /> 1' ZO �_ APPLICATION MUST BE SIGNED• <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />