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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> / PROPERTY OWNER INFORMATION <br /> CUSTOMER TO PROVIDE 6 <br /> OWNER NAME ‘ 1• <br /> The Bruce Company of Wisconsin, Inc. ❑Zoning Status; cuP; \ `� <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM �� <br /> 2830 Parmenter Street,Middleton,WI 53562 NC Q C e Co, Variance(# ) <br /> HOME PHONE CELL PHONE E-MAI AB DRESS <br /> (608)836-7041 t .1 t^V A I/ - C Q. C Oft( ❑Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Seth Nicholson The Bruce Company ❑Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> The Bruce Company,2830 Parmenter Street 2830 Parmenter Street <br /> (City,State,Zip) (City,State,Zip) ❑Setbacks <br /> Middleton,WI 53562 Middleton,WI 53562 <br /> PHONE PHONE <br /> ❑Site Plan approval from <br /> (608) 836-7041 (608) 836-7041 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ❑Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRNTZONIN ACREAGE: <br /> ❑PARCEL <br /> NUMBER <br /> 040/0508-204-8510-7 ,-L i �� frontage drawn to scale. <br /> TOWNSHIP: SECT N: <br /> Town of Montrose /4.S C //: 0,) r v <br /> ❑ Driveway permits <br /> ADDRESS: (state, county, town) <br /> 713 Kelly Drive, Belleville, WI <br /> ❑Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public, private) <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> Addition to machine shed ❑ Zoning District <br /> . ❑This project is a new building or structure. <br /> Li Permitted Use? <br /> fil This project is an addition/ Iteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: 1:1 Rural Address <br /> EWER EPTIC 3 —dt0 1"7 —D0(J 0-5- new/existing) <br /> HEIGHT IN FEET <br /> it.:/ NUMBER OF STORrS: (Not including basement) <br /> ❑ Wetland/Floodplain/ <br /> Shoreland (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: ?/` ❑ (slopes,disturbance,trot permit <br /> (` P 4, TOTAL SQUARE FOOTAGE: 4, (slopes,dis <br /> filling/access) <br /> 2ND FLOOR: 3RD FLOOR: <br /> R 6 0 ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ ♦ and available options. <br /> (Please round to nearest dollar) , , e.,0 <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes ONo ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? nYes ❑No (Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? QYes ENO <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes NI 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 ONo ❑Don't know <br /> 7. Is this to correct a violation? ['Yes ❑No <br /> ../ <br /> 545-112(4/O8) <br /> 4 APPLICATION MUST BE SIGNED <br /> (Continue on Back) ■ ■ -+ <br />