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SUPPLEMENT to Web-App # <br /> ZONING PERMIT APPLICAI1ON vwwkoourtyvfdalnaoom <br /> PROPERTY OWNER INFORMATION C STOMER TO PROVIDE <br /> OWNER NAME Josh Uselman <br /> V zo ' g Status; CUP; <br /> 33i5tot sS�iggelkow oad �pcFarland, WI 53558 D ed Restriction; CSM <br /> riance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 608-535-2808 juselman1@gmail.com .ite Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION an I eludes dimensions <br /> AGENT NAME C NT TOR mAME <br /> OS se an 4 ite Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRES f well/septic <br /> 3317 rugger Place <br /> (City,State,Zip) ( it,State,Zip) Setbacks <br /> Tic Farland, WI 53558 <br /> PHONE PHONE 0 S' Plan royal from <br /> 608-535-2808 ppli a township. <br /> E-MAIL ADDRESS E-MAIL ADpRESS <br /> juselman1@gmail.com Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (h ttp://accessdane.co.dane.wi.us/) evation of property <br /> PARENT PARCEL NUM • <br /> ^ 9 /f[� CURRENT�7QNI�ZNG: ACREAGE: O ge drawn to scale. <br /> 0NUMBER ® 1 1© ^3 d ^( I J^O �I--{{�H <br /> TOWNSHIP: SEC �- <br /> Blooming Grove � 1/4. N ry %y4. Sly riveway permits <br /> state,county,town) <br /> 3.. l 1 SS Lot 2 Siggelkow Road <br /> CSM:�Ipp LOT SUBDIVISION BLOCK/LOT - itary ri ate) <br /> 14423 2 p •lie,private) <br /> PROPOSED PROJECT INFORMATION If STAFF REVIEW <br /> P OJECT DESCRIPTIOIJ: <br /> New construction single family residence • 'oning District <br /> . 151 This project is a new building or structure. hi Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> i I Address <br /> SANITARY SERVICE:EWER EPTIC PER�I&UMB�:� 1 ^ 0 0�� <br /> �,-- .. � 7 - /existing) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 22 1 • V etland/FI plain/ <br /> AREA TO NEAREST SQUARE FOOT: Shore! (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl pe ' <br /> BASEMENT 2372 1ST FLOOR: 3520 ,+, TOTAL SQUARE FOOTAGE: ,, (slopes,distu nce, <br /> filling/a ) <br /> 2ND FLOOR: 3RD FLOOR: 5892 <br /> Ce <br /> ❑ Re • w Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ -► ♦ ♦ ♦ $ 278000 and available options. <br /> (Please round to nearest dollar) •p <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No (Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes 0 No Don't know <br /> 3. Have you talked with the township about your project and are they in agreement'? Efres II No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? IJYes M 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 0 No Don't know <br /> 7. Is this to correct a violation? Elves In No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► ■ —► <br /> 545-112(4/08) ? 0 <br /> U <br /> X 91 , <br />