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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 /> Ronald A Leikness Jr. <br /> ❑Zoning Status;CUP; <br /> OWNER ADDRESS(Number,Street,City,State,Zip) <br /> 1014 Cottonwood Dr.Stoughton WL 53589 V Restriction;CSM <br /> Variance <br /> (# ) <br /> HOME PHONE I CELL PHONE E-MAIL ADDRESS <br /> (608)408-3698 rleikne@att.net O Site Plan drawn to scale <br /> AGENT INFORMATION (CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> fl Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (city,State,Zip) [Setbacks <br /> PHONE PHONE [Site Plan approval from <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> O Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Ei <br /> O PARCEL 062/0511-171-2776-0 SFR-08 0.51 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Dunkirk 1/4; 1/4. O Driveway permits <br /> (state,county,town) <br /> ADDRESS: 1014 Cottonwood Dr. Stoughton, WI. 53589 <br /> CSM: LOT SUBDIVISION BLOCK/LOT --- ❑Sanitary permits <br /> 16 Rolling Acres (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Storage Shed ❑ Zoning District <br /> {This project is a new buildingor structure. ? <br /> y� P j ❑ Permitted Use. <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER SEPTIC — _ (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) <br /> BASEMENT: 1ST FLOOR: ❑ Erosion Control permit <br /> / K / ,,TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> �p l/ filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> f0 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: Q 2,000.00 <br /> and available options. <br /> $ <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? [Yes ✓ONo ODon't know <br /> 2. Is there a wetland or floodplain on or near the property? DYes [No ODon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Nes [No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? Oyes QNo <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 ONo ['Don't know <br /> 7. Is this to correct a violation? DYes ✓Jlo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) --e -e <br /> REV(01/18) <br /> I <br /> I <br />