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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 /> Travis & Mary Richardson Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 2214 Schroeder Ln., Stoughton, WI 53589 Variance(# ) <br /> HOME PHONE j CELL PHONE E-MAIL ADDRESS <br /> (608) 575-7904 JHConstruction81@gmail.com ['Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Scott Johnson Joe Hanson ❑✓ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1101 Johnson St. 985 Veium Rd. <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Stoughton, WI 53589 Stoughton,WI 53589 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 347-9955 (608) 575-7904 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Jhnviking@hotmail.com JHConstruction81@gmail.com Q✓ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: El Elevation of property <br /> ElPARCEL 2.67 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunkirk 1A: 1/: ❑Driveway permits <br /> (state, county,town) <br /> ADDRESS. 2214 Schroeder Ln., Stoughton, WI 53589 <br /> ❑Sanitary permits <br /> CSM: 5,888 LOT 1 SUBDIVISION BLOCK/LOT (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> ❑ Zoning District <br /> El 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 FTEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1.0 ❑ 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) ❑ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> 536.0 j TOTAL SQUARE FOOTAGE: j (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: 536.0 <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: --+► ♦ $ and available options. <br /> -+(Please round to nearest dollar) 56,500.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes ✓ONo QDon't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes QNo Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes Q✓ No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [fres E]No <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) QYes allo ElDon't know <br /> 7. Is this to correct a violation? Elves Q✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► -♦ <br /> REV(01/19) <br />