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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> ER NAME <br /> ' All-A nl * A N r0 A LJ to C nJ Gam-• ❑ Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction;CSM <br /> t35 N• Sovz'H ' -P1 (1:0 ' rY►u y,e-L-IQ tL (elan L4 Variance(# ) <br /> HOME PHONE CELL PHONE E-MAIL ADDRESS <br /> 841 -"lei ---7 7-43 ❑ Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> ❑ Site Plan including location <br /> AGENTADDRESSHRIS MILLER CONST. LLC CONTRACTOR ADDRESS NSA.\-� of well/septic <br /> 3185 KINNEY RD. ott�,v GQ SI0 <br /> (City,State,Zip)COTTAGE_GROVE,WI 5352; (City,State,zip) GHP't9 1gF,K\N )E W1 c.,,2,52-. ❑ Setbacks <br /> PHONE O 11:41E C,�J ❑ Site Plan approval from <br /> PHONE applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> 0 Floor plans to scale <br /> CAI r■S• re" i 1 l o r cay...S-Vr u C 't e r1f rna.■k,c o <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.usl) ❑ Elevation of property <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: frontage drawn property <br /> scale. <br /> ❑ NUMBER OSb 16Sag-dJ'�"do23 -D �H.- ( 3.O <br /> TOWNSHIP: SECTION: ❑ Driveway permits <br /> 5Qg I f.i Cm-F t LP '/°: '/'/4: (state,county,town) <br /> ADDRESS: g <br /> /� <br /> a✓•A40 fort` ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT (public,private) <br /> ..') HArt.rno tJ liI■ 'D <br /> PROPOSED PROJECT INFORMATION 4 S� R� ; <br /> PROJECT DESCRIPTION: <br /> . E This project is a new building or structure. `ermitted Use? <br /> ❑This project is an addition/alteration to an existi 0 ng building or structure. <br /> PERMIT NUMBER: a �1 <br /> SANITARY SERVICE: ' <br /> (SEWER REPTIC 13-2_015 - 0o2.--2-0 (t1� ~ <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 3!5 I a- Shorelanct lOttac hment). <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) Elf ! <br /> BASEMENT: 1ST FLOOR: 4100*41�._ <br /> C, TOTAL SQUARE FOOTAGE: j <br /> 3000 4 t- 65., o%� f iirlgi' ) <br /> 2ND FLOOR 3RD FLOOR: v�� o 5 . ©0 <br /> t3 Review;L rvey <br /> ESTIMATED CONSTRUCTION COST: $ i �,� and8'V ?� <br /> -�► -�► -.► .+ -�► -► $ <br /> (Please round to nearest dollar) ° ' <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes IENo ❑Don't know <br /> near the property? LJYes No §D Don'tknow <br /> 2. Is there a wetland or floodplain on or <br /> 3. Have you talked with the township about your project and are they in agreement'? Yes No <br /> ® <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 /> ,6. Is a location survey required? (see reverse) El Yes O No ❑Don't know <br /> 7. Is this to correct a violation? ['Yes t2 No <br /> / yt 0 7� APPLICATION MUST BE SIGNED <br /> (� (Continue on Back) -4 -► <br /> 545-112(4/08) <br />