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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT-to:Web-App#;
<br /> PROPERTY iOWNER'INF,ORMATION$ '; ai.i.:_:. ` ' 114 . .:. _ • "`: CU'TOMER TO PROVIDE
<br /> OWNER NAME
<br /> 3‘,..-4-r A�{_t(;- H E::\c �) ^ J Zoning Status;CUP;
<br /> OWNER ADDRESS (Number,Street,City,State,Zip)
<br /> Peed Restriction;CSM
<br /> 11 au.- L_CA...3--CLA. aL) e)--1-'' (hr" l�q LL , 0,)( 51555'
<br /> Y/ariance(# )
<br /> HOME PHONE l CELL PHONE E-MAIL ADDRESS l'
<br /> . // '; 2 5 ite Plan drawn to scale
<br /> AGENT INFORMATION .:: _r „ ,v _, CONTRACTORJNFORMATIONMMM«,'M w'z- : an includes dimensions
<br /> AGENT NAME CONTRACTOR NAME '
<br /> c
<br /> -S-..- 1 r� 1-"1 -., f\C-:,e^.3—c. VI ite Plan including location
<br /> AGENT KdDRLESM!LLER CONST. LL C CONTRACTOR ADDRESS f well/septic
<br /> 3186 KINNEY RD. .
<br /> (City,st iefap;F GE GROVE, WI 5352', (City,State,Zip) Setbacks
<br /> PHONE PHONE • ❑ ite Ianproval from
<br /> —,g.--7 7 -- / 3 (v 4� 'e l I {r.7 c's -2-.-3- —1 10 (ID 4 icaele township.
<br /> E-MAIL ADDRESS E-MAIL ADDRESS i 1
<br /> C4'FI r plans to scale
<br /> PROPERTY/LOCATION INFORMATION :(http:llaccessdane co danewi us,) , - levation of
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: property .
<br /> ❑ PARCEL 3,g p c-3 iron e drawn to scale.
<br /> NUMBER •C i z 331 9 i(cs O �+ ,�
<br /> TOWNSHIP: SECTION: � 1� ("
<br /> Y ,S 33 'A. 'V 1`, ,/,/� '�/� 1 ( co permits
<br /> ADDRESS: '� �— ( te,county,town)
<br /> • . \/ .11 I ` ( L, . itary permits
<br /> 'SM: �� LOT i� SUBDIVI•ION '=LOCKILOT U• c,private)
<br /> PROPOSED PROJECT:INFORMATION .' ; ;.< zt`"'. `. >_,r-t .. _.,_r.,,. ..;;_,'` TAEf*RE,17tE1t{r -r
<br /> PROJECT DESCRIPTION: -,-
<br /> �,?6':. .,x°1
<br /> l ` i lr ,alnf,};31SgiCt .mom
<br /> . This project is a new building or structure. 0 go` - �
<br /> Tom_
<br /> LI This project is an addition/alteration to an existing building or structure. �' s-- -!
<br /> SANITARY SERVICE: PERMIT NUMBER: /� T2--' td ,4i_
<br /> El SEWER SEPTIC /, Q/ l )0 O�0 _- -� a „ �
<br /> HEIGHT IN kE • f NUMBER OF STORI[S: (Not including basement) — �x -
<br /> A. 'r -
<br /> ' anpus /aq€- - e
<br /> AREA TO NEAREST SQUARE FOOT: --� =
<br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) 6E ®S . � e[#t 3
<br /> BASEMENT 1 ST FLOOR: , -.
<br /> L' TOTAL SQUARE FOOTAGE: ▪S� r r
<br /> l, /r 1,99 I _3 "7 Z � 4, 4, ,& t o ,&,M -
<br /> 2ND FLOOR: 3RD FLOOR: —� -"
<br /> r mil;
<br /> ESTIMATED CONSTRUCTION COST ♦ ♦ ♦ ♦ -► �� M /� 7- : 6`s a s, g Q
<br /> Please round to nearest dollar F rA 0 :g= -
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Si Yes ❑ o M Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes L�J No 0 Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement? 81Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes 'I No
<br /> 's this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> b. ,s a location survey required? (see reverse) ❑Yes 14 No ❑Don't know
<br /> 7. Is this to correct a violation? ❑Yes C2 No
<br /> ' :6-1 y -7 ? r -- APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -i -► -►
<br /> 545-112(4/08)
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