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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 /> OWNER ADDRESS (Number,Street,city,State,Zip) 0 Zoning Status; CUP; <br /> Deed Restriction; CSM <br /> 1608 W South Street Stoughton, WI 53589 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> (608)770-6906 raswitzky©gmail.com <br /> Q Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Self E51 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 apprgva'ffrom <br /> applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: P P rty <br /> 0 PARCEL 0509-223-8080-0 z�.i-R3-• 8.07 frontage drawn to scale. <br /> NUMBER <br /> TOWNSHIP: SECTION: t■ y' <br /> Oregon 22 +/; +/4+/. c 0 D ' eway permits <br /> ADDRESS: fte,county,town) <br /> County Highway A y 1 9 >' <br /> Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> 13 841 A (publjo,private) <br /> PROPOSED PROJECT INFORMATION REVIEW <br /> PROJECT DESCRIPTION: <br /> 04, (4 .... !_ . „ e k I El .�F I ng Distdct <br /> . Q This project is a new building or structure. 0 ;. - Q use? <br /> This project is an additiolyalteration to an existing building or structure. <br /> SANITARY SERVICE: / PERMIT UER: t. �'. , t "'a <br /> EWER [EPTIC / ,. 0:3 ,,Sling) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not induding basement) <br /> 24.5 1.03 °. <br /> AREA TO NEAREST SQUARE FOOT: .4 „ (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ( ro <br /> 5.„i'cP�s�'+'a ix e s • <br /> BASEMENT: 1ST FLOOR: <br /> 3,024.0 4, TOTAL SQUARE FOOTAGE: 4, 0401008* o r ' i r <br /> 2ND FLOOR: 3RD FLOOR: 3,024.0 <br /> I Review Location Survey 1 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) $ 82,800.00 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes []Vo ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? 01'es ✓ '4o QDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes alo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? feI'es []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) E3Yes EiNo QDon't know <br /> 7. Is this to correct a violation? Dyes EjNo <br /> • ,t t APPLICATION MUST - SIGNED <br /> 545-112(4/08) 41 0) '7(b' vx (Continue on Back) -e. -+ <br />