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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> 3.fimes FA ��GIZZ .G n Zoning Status; CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) <br /> 4i9 -Par_k� ‘e.(,3 RI), -17-66.2-E ,EL,D W ( 5353 Variance Restriction; CSM <br /> HOME PHONE CELL PHONE ariance(# ) <br /> E-MAIL E-MAILADDRESS <br /> 6008- 24 2-I 1 7 3 c....- rkae; --D.-..Se -43 r-wi ,_ a Si Ian drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> CHRIS MILLER CONST. LLC K. Site Plan including location <br /> AGENT ADDRESS 3186 KINNEY RD. CONTRACTOR ADDRESS of well/septic <br /> COTTAGE GROVE, WI 5352 HIlIS mum'CONST. LLC <br /> (City,State,Zip) (City,State,Zip) tbacks <br /> 3186 KINNEY RD. <br /> PHONE PHONE COTTAGE GROVE,WI 5352: Sitepproval from <br /> appl. I township. <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> Ck ',,s•r n+ Iles e n 4 1 S s-E-;.;mot∎ ,G") •C El F• or plans to scale■ <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> ElPARCEL <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: Be tion of property <br /> NUMBER of IZ'324-9-130 — 0 R\--k /°45• 2, O outage drawn to scale. <br /> TOWNSHIP: SECTION: <br /> 1 .EC F ■EL--o , .1/4: ,/,/4. t] D• riveway permits <br /> ADDRESS: (state, county,41 <br /> 1/ kea 1 ' `'1 _ Pc S• anitary permits J <br /> CSM: ( 4 LOT SUBDIVISION BLOCK/LOT <br /> ,S (t, 1 (public,__ Q <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: <br /> 6 IN GLe -ft -r ?FS, ®Zoning District <br /> ,This project is a new building or structure. Permitted Use? <br /> This project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: PERMIT NUMBER: ❑ Rural Address <br /> (SEWER SEPTIC j3 - as 1' - 0005 3 ( (new/existing) <br /> HEIGHT IN FEET: I n NUMBER OF STORIES: (Not including basement) <br /> 2 ( /5= l S I- Li Wetland/Floodplain! <br /> AREA TO NEAREST SQUARE FOOT: Shoreland (attachment) <br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: ❑ EfOS10f1COf1tYt51 permit <br /> $ 2 3 23 5 4, TOTAL SQUARE FOOTAGE: 4, (slopes,disturbance, <br /> 2ND FLOOR: 3RD FLOOR: filling/access) <br /> 511o`7. 0a <br /> ❑ Review Location Survey <br /> ESTIMATED CONSTRUCTION COST: .."4.,S(1), and available options. <br /> (Please round to nearest dollar) ♦ ♦ ♦ ♦ -� -► <br /> /f tk <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? 0 Yes N No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? n Yes N No fl Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? N Yes n No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? 0 Yes N 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) E Yes fl No n Don't know <br /> 7. Is this to correct a violation? 0 Yes No <br /> APPLICATION MUST BE SIGNED <br /> 545-112(aios) (Continue on Back) -♦ ♦ -.+ <br />