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Ili. <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT teWsIrApPS <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> JAMES A TJUGUM <br /> -- --- . n Zoning Status; CUP; <br /> O'wNER ADDRESS (Number,Street.City.State.Zip) Deed Restriction; CSM <br /> 1668 SPRING RD STOUGHTON WI 53589 Variance(# ) <br /> —. <br /> HOME PHONE ;CELL PHONE E-MAIL ADDRESS <br /> 843-9733 n Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp ['Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli St <br /> (City,State,Zip) (City,State,Zip) ['Setbacks <br /> Verona,WI <br /> PHONE PHONE ['Site Plan approval from <br /> (608) 379-0. 132 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tleeser@clearybuilding.com n Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.danemLus/) n Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: I ACREAGE: <br /> ['PARCEL 046/0611-344-8700-0 RR-4 i 5.01 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Pleasant Springs 34 +/: NW +/a+�a: SE n Driveway permits <br /> ADDRESS: (state,county,town) <br /> b. 1668 SPRING RD <br /> , GSM : I LOT SUBDIVISION BLOCwLOT4. ❑Sanitary permits <br /> 10,722 2 (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> /4bsq ft cold storage storage shed J Zoning District <br /> ❑✓ This project is a new building or structure. <br /> J Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: J Rural Address <br /> [EWER PEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 19.0 1.0 J 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: J ErosionControl permit <br /> 4, TOTAL SQUARE FOOTAGE: ,, (slopes, disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> Li Review Location Survey <br /> I <br /> ESTIMATED CONSTRUCTION COST: Q �144uand available o tions. <br /> (Please round to nearest dollar) -► "+ -► ♦ •pJ0,000.00 p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ®Yes Jlo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes JNo ['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? Des ✓nNo <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) • nYes . J)o ['Don't know <br /> 7. Is this to correct a violation? EYes nNo <br /> (/‘)eii r o 3 APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -+ <br /> 545-112(4/08) <br />