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zor it r APPLJCA flCN n SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Timothy & Kathleen Wilson <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1300 Garden Ave. Stoughton, WI 53589 variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-698-2118 wilsn5ayahoo.com to Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Timothy Wilson lElite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic . <br /> 1300 Garden Ave. <br /> (City,State,Zip) (City,State,Zip) Ietbacks <br /> Stoughton, WI 53589 <br /> PHONE PHONE ' e Plan approval from NA <br /> 608-698-2118 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> wilsn5Ayahoo.com [ loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) levation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> IZ <br /> PARCEL 0510-222-8660-7 RH-1 3.21 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION^:� <br /> Rutland a of 1/4: ,N lJ '/< : )4 UJ 'riveway permits <br /> ADDRESS: (state, county,town) <br /> CSM: 7 653 LOTC-e'"- ev- SUBDIVISION BLOCK/LOT anitary permits '?J .81:k.81:k(public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 5 S V\P FgMt1 1-eSt��� - 3 Q.thrno n,-� CJ Zoning District <br /> This project is a new buildt>�g or structure. 2 Perrnitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ ' Address <br /> EWER IEPTIC 13-2018-00013 0-xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> Mean 1 D tland/Floodplain/ )a <br /> Shoreland (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) rOSIOnCOntrol permit df'(�W49 <br /> BASEMENT: 1ST FLOOR: pe K10 t <br /> 294$ p431. <br /> TOTAL SQUARE FOOTAGE: (sl0 s,disturbance,// a'�� 3 1 filling/access) 7 IBS.c4 <br /> 2ND FLOOR: 3RD FLOOR: ��,, <br /> 41, 5 aQ6-) GL R€view Location Survey J.JA <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 325000 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Elves INo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes gNo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? IZIYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Eves FZ1No <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 IZNo ❑Don't know <br /> 7. Is this to correct a violation? Dies Jlo <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aioe) (Continue on Back) <br />