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•ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App#. <br /> • <br /> PROPERTY'OWNER'INFORM.TION . }--c -.. tip= ',:; fit: Ai:> t; < ; . ` CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> C)t' ) 1G k 4- RR 2E Li -e.N U ❑ Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> V 3'12-i I ? YT C IA 1,...D P'P PAR-PGC C∎u,€ W I 5 395 f Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 22' s ❑ Site Plan drawn to scale <br /> AGENT INFORMATION „_ CONTRACTORzINFORMATJON M and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CHRIS MILLER CONST LI C - Site Plan including location <br /> AGENT ADDRESS 3186 KINNEY RD. CONTRACTOR ADDR s <br /> COTTAGE GROVE WI 5352; CHRIS svlILLER CONST. LLC of well/septic <br /> (City,State,Tip) 3186 K <br /> (CitY,State.zip1OTTACIF GROVE, WI 5352 Setbacks <br /> PHONE PHONE CC • ❑ Site Plan approval from <br /> 6,-'-T1'3 -I Ito6 0g(( ( O ' -2(36 -( 1pb applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> r',S, m I 1 Qr_(2e•n e. -1-r t)C- 1 es--AD rr(_(. , I. CcryN ❑ Floor plans to scale <br /> PROPERTY/LOCATION;INFORMATION (http://ac‘essdane co lane wi.usn;' r . : <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: ❑ Elevation of property <br /> ❑ F4Rm ER 57; I-O 34--844( -4- RA_.:2_ S• 6 68 frontage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> Con e (2-0-0 E. ,A: ,/,/: nveway permits <br /> ADDRESS: , <br /> LI'S r. ����(state,county,town) <br /> LYSanitary ps -.its <br /> ^SM: LOT SUBDIVISION BLOCK/LOT <br /> M{ (public, . ate) <br /> PROPOSED PROJECT-:INFORMATION, • . V. t <br /> .` - -! � 4TAW:,REj71E3tIT . - ' <br /> PROJECT DESCRIPTION: c.�/ ` <br /> • This project is a new building or structure. �7 ` <br /> ❑This project is an addition/alteration to an existing building or structure. _ �_ <br /> SANITARY SERVICE: PERMIT NUMBER: �f(ca14Aao G£SS:�` 7_ <br /> ❑SEWER SEPTIC / - t� � ��f <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) <br /> -�tarxd'/Fiie m f a <br /> AREA TO NEAREST SQUARE FOOT: W - 4- b- <br /> (Outside dimensions including unfinished area attached garages and above grade decks or porches) _.' : <br /> BASEMENT 1ST FLOOR: Eft Co�Ltro;pe i <br /> 2 3,31 { • :C5 4, TOTAL SQUARE FOOTAGE: 4, PAS sf S I dnc tea v'`,#3,,, <br /> [11282ND FLOOR: 3RD FLOOR: • fttl_ : - gels-..: -,,-, , <br /> Review o i 0 rh'e - <br /> STIMATED CONSTRUCTION COST 4� s°�A � ' <br /> lease round to nearest dollar) --► ♦ --► ♦ $ Z.,p. d,0J a tea6 e�j3 Qr� <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes "Ilo LI Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ' No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? N,RtYes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ,'No <br /> 5 Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> a a location survey required? (see reverse) CI Yes Jo LI Don't know <br /> 7. Is this to correct a violation? ❑Yes 1 o <br /> 5 e—N. TrS' <br /> DECtz 2-0 0 <br /> GAS I05'Z li” <br /> APPLICATION MUST BE SIGNED <br /> T'�c.-P Zi (Continue on Back) -► -► -► <br /> 545.112(4/08) h,+A,,.,_ I tafr?- <br /> 534(•2( <br />