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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION <br /> CU 'TO M E R TO PROVIDE <br /> OWNER NAME <br /> k el llr/ Mar k l 1441 111•14 al oning Status; CUP; <br /> OWNER ADDRESS (Number,Street.City State Zip) D ed Restriction; CSM <br /> 5 I0 q Fal Ii N6 Lico/4 OA, Mc Fatrlavld, WI 5 35 5 8 ariance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 408133- 1312 008•228-7172 nark.kelltr 6 w i 6 C. tdu Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and inclu s dim sions <br /> AGENT NAME CONTRACTOR NAME <br /> Tomple 8ui 1dar$ LLC. T %IpId. BU►H4I1 LLC. ❑ ite P in I n location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of wel s c <br /> 2.501 w 8t1-Ni ie Hwy, Suitt (13 2501 W &I lit µwyi Suitt 113 <br /> (City,State;Zip) (City,State.Zip) Setbacks <br /> Matti 40k1/ WI 53713 M•disavl, WI 53713 <br /> PHONE PHONE ❑Site Plan royal from <br /> 4 0 g- 7241- 39 90 Gag~ 7 2.9 - 3 910 pplic e township. <br /> E-MAIILADDRESS 1 bid `` E-MAIL ADDRESS <br /> +eVIIpiJ�.@4 I+IpIibidI Idle C1141 . }tmlv14. 6+1Yr1plebui le15.COW1 loor plans to scale <br /> PROPERTY/LOCATION INFORMATION (httpJ/accessdane.co.dane.wl.usJ) <br /> PARENT PARCEL NUMBER: CURRENT ZONING ACREAGE t C. levation of property <br /> ❑PARCEL 044/o"I-33l1-3 534.0 Q 1 ( y . frontage drawn to scale. ` <br /> NUMBER '1 ICJ <br /> TOWNSHIP: SECTION: <br /> ?I Qay4Vi'i- Seri h 5 �� [ '/: NI W '/1/4: ME ❑Driveway permits CQh <br /> ADDRESS: p �. 9 (state,county,town) C M\ 1 • <br /> C`J . C-, 1 nne i k)O ()Jr I v ❑Sani rytmtA___CSM: LOT SUBDIVISION BLOCK/LOT <br /> 3 5 &r (briar esto tS (pu i , <br /> PROPOSED PROJECT INFORMATION AFF REVIEW <br /> PROJECT DESCRIPTION <br /> 6i14614 Runny 'RQSidoiCL ( C of. ; Q 6C W. oning District <br /> . ,This project is a new building or structure. ermitted Use? <br /> ❑This project is an addition/alteration to an existing building or s u re. <br /> SANITARY SERVICE: PERMIT NUMBER ❑ I Address <br /> XVVER rIEPTIC N (ne /existing) <br /> HEIGHT IN F NUMBER OF STORIES (I of including basement) <br /> !// ❑ Wetland/F odplain/ <br /> Shore! d (attachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR ❑ ErosionControl mit <br /> 28(f .�, ,S66'� 4, TOTAL SQUARE FOOTAGE: 4, (slopes,dis ante, <br /> 2ND FLOOR: U ( 3RD FLOOR, , \����JJJ 59 SA filling/ac ss) <br /> 0 l�t raxV <br /> ❑ Revi w Location Surve <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ $ 5-if5. 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? ❑Yes ,No ['Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 1No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? es No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? es J�-�'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) ❑Yes No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes No <br /> APPLICATION MUST BE SIGNED <br /> 4.5 s, iaio i(L�°,t (Continue on Back) -♦ ♦ -i <br /> 11 <br /> 14 % � 6 <br />