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, ,b)p(AC <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Schuyler Pierce ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 5456 Broken Bow Rd Sun Prairie,WI 53590 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)712-3325 ['Site Plan drawn to scale d2" <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions V <br /> AGENT NAME CONTRACTOR NAME <br /> Cleary Building Corp ['Site Plan includirwsration <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> 190 Paoli St <br /> (City,State,Zip) (City,State,Zip) Q Setbacks \/ <br /> Verona,WI <br /> PHONE PHONE 0 Site Plan rom <br /> E-MAIL ADDRESS E-MAIL ADDRESS (608) 379-0'I32 applicabl sip. <br /> tleeser@clearybuilding.com Q Floor plans to scale 0 � <br /> 1, 'l/ , <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 01--M I Jv <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ['Elevation of property ►►��""" <br /> 0 PARCEL 014/0810-241-7089-3 A-2 1.09 frontage drawn to scald. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Burke 1/4; SE +%1/; NE ❑Driveways <br /> ADDRESS: (state,co n w ) <br /> 5456 Broken Bow Rd <br /> El CSM: LOT 9 SUBDIVISION BLOCK/LOT �P nita p I) /�, ,n <br /> Ubli i IU/� <br /> PROPOSED PROJECT INFORMATION STAFF ,EVIEW <br /> PROJECT DESCRIPTION: �B/ �, <br /> 54x48 shed LI Zoning Istnct �,�� �T�, <br /> . INI This project is a new building or structure. <br /> ❑ Permitted Use? <br /> ❑This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> EWER r)EPTIC (new/e?tt's ) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) `/ <br /> 26.8 1.0 LI Wetland/Floodplain/ <br /> AREA TO NEAREST SQUARE FOOT: <br /> Shoreland (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ ErosionControl permit <br /> TOTAL SQUARE FOOTAGE: j, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: <br /> filling/access) <br /> 2,862.0 _ ❑ Revie L. urvey CONSTRUCTION COST: $ 80'000.00 i ,lit' S. <br /> y <br /> (Please round to nearest dollar) -♦ .- ' -'� and av- .%/• <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ✓Y to ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? QYes 1/ o QDon't know <br /> Q <br /> 3. Have you talked with the township about your project and are they in agreement? Yes ✓ to <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes ✓ONo <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 Qnlo ['Don't know <br /> 7. Is this to correct a violation? QYes ✓[' to <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -e. -► -+ <br /> 545.112(4ro8) <br />