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ZONING PERMIT APPLICATION www.countyofdane.com 7:1 <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Travis & Mary Richardson <br /> EJ 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 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 Q 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 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL g' --7- 2.67 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunkirk 1/4: 1/4: ❑ Driveway permits <br /> ADDRESS: - (state, county,town) <br /> 2214 Schroeder Ln., Stoughton, WI 53589 <br /> CSM: 8 LOT 1 SUBDIVISION BLOCK/LOT <br /> 5 88 — ❑Sanitary permits <br /> 8 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION:' <br /> tD.._�J- -jam 5 GA..LL,^ I rte, ❑ Zoning District <br /> . ❑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 rEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 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: 1ST FLOOR: ❑ ErosionControl permit <br /> 536.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 536.0 <br /> Li Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ 56,500.00 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? [fres ❑✓No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes EINo ❑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 ❑✓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) ❑Yes QNo ❑Don't know <br /> 7. Is this to correct a violation? [fres ❑✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ <br /> REV(01/19) <br />