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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Andrew Halverson <br /> El Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street.City.State.Zip) Deed Restriction; CSM <br /> 2522 County Hwy A Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)213-8384 ahalverson74 @gmail.com ❑Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Dave Budden Andy Halverson ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wellseptic <br /> 1527 Hwy 14,P.O.Box 412 2522 County A <br /> (City,State.Zip) (City.State.Zip) ❑Setbacks <br /> Black Earth,WI 53515 Stoughton,WI 53589 <br /> PHONE ❑(608) 767-4622 PHONE (608) 213-8384 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dave @meigsbuilds.com ahalverson74@gmail.com ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wLusl) ❑Elevation of property <br /> PARENT PARCEL NUMBER: CURREN ZONING: ACREAGE: <br /> ❑PARCEL 026/0511-092-9890-0 A" - 2.49 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunkirk 9 y4: SE 1 4+/4: NE ❑Driveway permits <br /> ADDRESS: (state, county,town) <br /> 2522 County Hwy A, Stoughton, WI 53515 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 14,079 (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Accessory Building-Storage ❑ Zoning District <br /> . rAThis project is a new building or structure. LI Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER rEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 19.2 1.o ❑ Wetland/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 /> 1,620.0 4 TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> 1,620.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ¢ and available O tions. <br /> (Please round to nearest dollar) -- i i — — –' $ 15,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? [Yes ✓❑Plo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? :Yes go ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes [[No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years?a,e ❑Yes ✓ lo <br /> �a <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#x,1 i- it(5R) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) v ❑Yes �10 ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes ✓INO <br /> APPLICATION MUST BE SIGNED <br /> salttz,anel (Continue on Back) ■ –► -+ <br />