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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICATION www.countyofdane.com <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Gary Schneider ❑Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street City,State,Zip) Deed Restriction;CSM <br /> 1655 LAKE KEGONSA RD STOUGHTON WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)501-7998 ❑Site Plan drawn to scale <br /> AGENT INFORMATION I 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 0 Site Plan approval from <br /> (608) 379-0132 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> tleeser @clearybuilding.com ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) 111 Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: <br /> ❑PARCEL 028/0610-353-8220-9 RH-3 10.05 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: <br /> Town of Dunn 35 IA; NE 1/4+/4. SW ❑Driveway permits <br /> ADDRESS: (state,county,town) <br /> 1655 LAKE KEGONSA RD <br /> CSM: LOT SUBDIVISION BLOCK/LOT ❑Sanitary permits <br /> 5,660 1 (public,private) <br /> PROPOSED PROJECT INFORMATION `` y <br /> PROJECT DESCRIPTION: <br /> 42x64 Storage shed 6? a = . <br /> . 151 This project is a new building or structure. '* , ,f,!::-:- <br /> ❑This project is an addition/alteration to an existing building or structure. '• <br /> SANITARY SERVICE: PERMIT NUMBER: '° i`' <br /> EWER FIEPTIC <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 21.0 1.o V xl <br /> 9 <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> o <br /> BASEMENT: 1ST FLOOR: 1 TOTAL SQUARE FOOTAGE: <br /> 5 4 <br /> 2ND FLOOR: 3RD FLOOR: <br /> 2,688.0 <br /> 4 i r <br /> ESTIMATED CONSTRUCTION COST: 'i I ,•(Please round to nearest dollar) _p ♦ _o. .4. ♦ -. $ s 80 000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Dies ❑✓No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? [Yes al° ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ❑Yes ENo <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) DYes ONo ['Don't know <br /> 7. Is this to correct a violation? ❑Yes [No <br /> AIAUT BE SIG N ED <br /> (Continue PPL C on TION Back)MS -i <br /> 545-112(4/08) <br />