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ti <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Jesse Sullivan <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2060 River Estate Ln. Stoughton, WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (920)728-3055 ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Wendorf Construction Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> PO Box 534 <br /> (City,State,Zip) (City,State,Zip) backs <br /> Stoughton, WI 53589 !` <br /> PHONE PHONE ite Plan approval from <br /> (608) 279-1211 applicable township. ,11, <br /> E-MAIL ADDRESS E-MAIL ADDRESS /���`� <br /> adam @wendorfconstruction.com Floor plans to scale x <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) i <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑Elevation of property O <br /> ElPARCEL 0712-103-9055-4 -RH-2 1 4.04 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: cut. <br /> DeerField 10 1/. T7N 1/4+/. R12E Driveway permits `� <br /> ADDRESS: ` (state,county,iV" `�, <br /> �6 3 CnY 0 1 Zanita •- its <br /> W <br /> CSM: 7,832 LOT 3 J SUBDIVISION BLOCK/LOT <br /> (public,pri - ') <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> New Residential Home ❑ Zoning District <br /> . 12 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 PTEPTIC • 1 3,201 ,700,219 (new/existing) <br /> HEIGHT IN FEET: ✓ NUMBER OF STORIES: (Not including basement) <br /> 25.0 1.0 ❑ Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: ::L0R_2 ❑ ErosionControl permit <br /> 210(4 + TOTAL SQUARE FOOTAGE: , (slopes,disturbance, <br /> 2ND FLOOR. Z LOOR: filling/access) <br /> cD `tom ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: $ 4 v c itY0 a0 and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ ♦ ♦ L/ <br /> l <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes \lo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes (✓to ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑✓Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years?U L/ ❑Yes 'lo <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#_/S ` ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes al. ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓ 4o <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ —► —► <br /> 545-112(4/051 <br />