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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 /> Robert A. Switzky <br /> Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 1608 W South Street Stoughton, WI 53589 <br /> Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)770-6906 raswitzky @gmail.com Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Setf 0 Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> (City,State,Zip) (City,State,Zip) 0 Setbacks <br /> PHONE PHONE ['Site Plan appr6val from <br /> applica ble`township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS .•�/ <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usn Elevation of property <br /> PARENT PARCEL NUMBER: CUf�2ENTZONING. ACREAGE: P P rty <br /> 0 PARCEL 0509-223-8080-0 nnKKrr//i.. 8.07 frontage drawn to scale. <br /> NUMBER r <br /> TOWNSHIP: SEC ION: ,75 w N 1= <br /> Oregon 22 1/: NE 1/1/: -fw MI Driveway permits <br /> ADDRESS: (state,county,town) <br /> County Highway A Sel-SCi El <br /> CSM: LOT SUBDIVISION BLOCKJLOT <br /> Sanitary permits <br /> 13 841 1 (public,private) <br /> PROPOSED PROJECT INFORMATION ST SETHE <br /> PROJECT DESCRIPTION: S 1 (� QI�� ' c Q_ L ng District. 0 This project is a new building or structure. ��• errttitta Use? <br /> ['This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: <br /> �` - <br /> EWER �, EPTIC ! J Z,Q 1 ". D O Z s D Wetand/' iti <br /> ainl HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> 29.0 1.0 <br /> AREA TO NEAREST SQUARE FOOT: (a chment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> 0 EtRCMttrta) <br /> BASEMENT: 1ST FLOOR: <br /> 1,606.0 3,841.0 4, TOTAL SQUARE FOOTAGE: 4, (slopes, e ' a:, . <br /> 2ND FLOOR: 3RD FLOOR: n�. t <br /> 5,447.0 0 Review Location Survey \, , <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ �available options. <br /> (Please round to nearest dollar) $ 550,000.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ['Yes ✓No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ['Yes o DDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? [Yes o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ,gfes J'lo <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? ['Yes tO�Vo <br /> ,J <br /> �:� k` APPLICATION MUST BE SIGNED <br /> q6R r" (Con tinue on Back) ♦ —►5-112(4/08) 4 <br />