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4 d- ,o h.4. e. Qe_e il <br /> 1,- ,D0( 44 pet - ___,c,e(,itipt-- <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to W® App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> Wisconsin Heights Elementary School Addition <br /> El Zoning Status; CUP;`t5 - <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM <br /> 10173 US-14,Mazomanie,WI 53560 Variance(# ) <br /> HOME PHONE ''CELL PHONE E-MAIL ADDRESS <br /> (608)767-2586 JSinz@wisheights.k12 wi.us E✓ Site Plan dr Ryfrfo scale red <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Jordan Sinz Performance Services D Site Plan includi atic <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic i isil <br /> 10173 US-14 N14W23833 Stone Ridge Dr.#210 t / <br /> (City State,Zip) (City,State,Zip) ✓Q Setbacks y1QQ0k (.6•P V <br /> Mazomanie,WI 53560 Waukesha,WI 53188 <br /> ✓Q Site Pla ��pproval from <br /> PHONE (608) 767-2586 PHONE (414) 367-5066 applica 1it15'1-ivnship. `? <br /> E-MAIL ADDRESS E-MAIL ADDRESS - <br /> JSinz@wisheights.k12.wi.us MBoettcher@performanceservices.com ❑✓ Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us!) <br /> PARENT PARCEL NUMBER: 771tiap� Elevation of property CURRENT ZONING: ACREAGE: 15'SaCRI_ <br /> PARCEL 006/06/46-222-•500-1 RM-16 41.57 frontage drawn to scale. <br /> NUMBER n.a, C/ AD? <br /> TO HI ce, SECTION: <br /> rosawiees, 22 1/4: SE 1A: NW ❑Driveway permits h.a,,rd /': <br /> (state, county,town <br /> ADDRESS: 10173 US HIGHWAY 14, MAZOMANIE WI 53560 <br /> 1—❑Sanitary permits /lecQ <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,privy i 56g,t <br /> d P t.I <br /> PROPOSED PROJECT INFORMATION - , ' <br /> PROJECT DESCRIPTION: <br /> Elementary school addition to existing Middle School/High School ❑ Zoning Iiiigrict <br /> LIThis project is a new building or structure. ❑ Permittdd Use? <br /> ✓QThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ RuralAd. -ss <br /> EWER pEPTIC (new/eat) <br /> HEIGHT IN FEET: •31.4- NUMBER OF STORIES: (Not including basement) <br /> wb1 31.02.0 13Wetlann�/IF�I�Iplam/ <br /> Shorel 1,Pllaachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> ❑ ErosionControl permit L <br /> BASEMENT: 1ST FLOOR: TOTAL SQUARE FOOTAGE: (slopes,disturbance, <br /> 0.0 81,014.0 j filling/access) ' W1 Z02-10057 <br /> _ <br /> 2ND FLOOR: 3RD FLOOR: <br /> 3,608.0 0.0 Q 4 84,622.0 <br /> V ❑ Review kop6on Survey s g <br /> ESTIMATED CONSTRUCTION COST: -p ♦ -► ♦ 20 000 000.00 and avtions. <br /> (Please round to nearest dollar) > <br /> aD©o0 a :-...-114,Cer + 25®-ems tibio ®r- ( . f&`br <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? QYes ✓[�No LIDon't know c-f-- 9 <br /> 2. Is there a wetland or floodplain on or near the property? nYes nNo LIDon't know <br /> 3. Have you talked with the township about your project and are they in agreement? ['Yes QNo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? QYes Q✓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) QYes ✓INo LIDon't know <br /> 7. Is this to correct a violation? ❑Yes Q✓No <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -* -► --PP <br /> REV(01119) <br /> Teu---biAi <br />