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-'1""' DANE COUNTY <br /> �o ZONING PERMIT APPLICATION WWW.DANECOUNTYPLANNING.COM <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Natasha Iverson <br /> ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1397 Ramsey Rd, Stoughton, WI, 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)873-1999 (608) 501-8017 jniverson @gmaiLcom ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Home Owner ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 1397 Ramsey Rd <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Stoughton, WI, 53589 <br /> PHONE PHONE ❑Site Plan approval from <br /> (608) 501-8017 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jniverson @gmail.com ❑ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: C� CURRENT <br /> /�ZONING::� ACREAGE: <br /> ❑NUMBER 0 5 2—e)61 0 SU v p 1'` r I Kam' 3�- frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Albion +/,: +/4: El Driveway permits <br /> ADDRESS: (state, county,town) <br /> 1397 Ramsey Rd, Stoughton, WI 53589 <br /> CSM: LOT SUBDIVISION BLOCK/LOT ID(public, permits <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Lean 2 off exitsting Shed Cl Zoning District <br /> ❑This project is a new building or structure. ❑ Permitted Use? <br /> IS This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> FIEWER <br /> NEPTIC (new/existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> I 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 /> j TOTAL SQUARE FOOTAGE: 4 (slopes,disturbance, <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: gel?,5 l <br /> 1 v t ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: —I. -► —0. ♦ DC: .) 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? nYes MI No (Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes ❑✓No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Dies ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? :Yes 0 N <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 IN ❑Don't know <br /> 7. Is this to correct a violation? Elves ONo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -+ —+ -+ <br /> REV(01/19) <br /> l <br />