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-:.SUPP,LEMENTto Web Apps#
<br /> ZONING PERMIT APPLICATION www.countyofdane.com .
<br /> PROPERTY'OWNER"INFORMATION `, ggi t_-.:_��'' ., `;. 3`_ A. .-_ _4< i :. ' CUSTOMER TO PROVIDE
<br /> OWNER NAME !^
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<br /> �gviD �-TgMMiE 5y.-�1�}}r3f�GC Zoning Status; CUP; 4 /c
<br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Restriction; CSM
<br /> (4f\ K,' i..•/ W,. "'PEGR t •
<br /> .v D ti., t 535 3 I • Variance(#_ . )
<br /> HOME PHONE CELL PHONE E-MAIL ADDRESS -
<br /> (poS 7ro4 `}1(• • kSite Plan drawn to scale
<br /> °AGENTj1NFORMA_TIO�1 ,' V `- `:�' yr � #CONTI4ACTOlta1NFOR(RATIO l y-,,a and includes dimensions A �AGENT NAME CONTRACTOR NAME
<br /> 0 Site ding location
<br /> AGENT ADCC $IS MILLER CONST. LLC CONTRACTOR ADDRESS �VG • ' of /septic
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<br /> 3186 KINNEY RD. �S'(.
<br /> (city,Slate,iQjQT7AtaE GROVE,WI 5352: (City,State,Zip) ����PV �3y`L' �►,'d Setbacks 3e/,(9/
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<br /> PHONE PHONE G��`3 CIS"' 416 Site Plan appr
<br /> from `//a applicable township. /1'
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<br /> E-MAIL ADDRESS E-MAIL ADDRESS C0
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<br /> kr Floor plans to scale
<br /> r' ,1(°r c t.v c_k. .. r•, C a /�/
<br /> 'PROPERTY/LOOATION INFORI)AA'1hON> (httpJ/accessdane,co,dane:vui.us/)� .-, _ Elevation of property /o
<br /> PARENT PARCEL NUMBER: .- CURRENT ONING: ACREAGE:
<br /> ElPARCEL r frontage drawn to scale.
<br /> NUMBER o1(0- �t Z -db`f_ A— Ems. 4o //
<br /> TOWNSHIP: E$o0_(o SEC N' ,�/� ',/
<br /> '/a: S 6 '/a'/a: ,�V ►v Driveway permi
<br /> akrA -r 1 A,J a �� (state, county,110
<br /> ADDRESS: •-SAc`rr, ft... Qr).),,Je/Z t Sanita
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<br /> CSM: LOT SUBDIVISION BLOCK/LOT C� y (P ubli � •
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<br /> PROPOSED PROJECT:INFORMATION ;' r--.- 9,-17-7.-_-4,--wS ig ' fi-
<br /> PROJECT DESCRIPTION: � ._� T - �
<br /> � ow-0 p-40:1-✓C- C5 Av1 10-co c lGG , gal 641)1 no!-'r
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<br /> This project is a new building or structure. Tc' `�'°`''-4^-� - 0�' 5u P- EF r � *E-� , ag{'c,.�
<br /> P J 9 ltd s ).10This project is an addition/alteration to an existing u11"
<br /> rng or structure. �� �.: ;, �� c c
<br /> SANITARY SERVICE PERMIT NUMBER: L,
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<br /> EWER EPTIC 13 -ZOI.(o " .00 1`1,0 �"..e�'}`''t'( ;�' ittrc,
<br /> HEIGHT IN FEET 1 1 NUMBER OF STORIES: (Not including basement) - L_ �/
<br /> 1 1F���r- e}ole a 1#31�* �,_+ r �!/'
<br /> si 4 Ita p511617:::
<br /> AREA TO NEAREST SQUARE FOOT — - , '��4
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) 3 o s L yi `"" °�
<br /> BASEMENT g 1ST FLOOR: ' g 9 P ) 4_.° P s� _e 0 r t 4'
<br /> TOTAL SQUARE FOOTAGE � €;06 ?C
<br /> I a 20 00 . �, 1"10. '_ l � /
<br /> 2ND FLOOR: 3RD FLOOR: •.4 ,y
<br /> . 2 ! 3L, 00 - a'.°-= °--" ,rc
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<br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ $ . )� ���� 11 �a e _ 14
<br /> (Please round to nearest dollar) ! 3 .. T, - = ,. .- .
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ElYes ' QNo NDon't-know
<br /> 2. Is there a wetland or floodplain on or near the property? [-Yes f No . Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Wes ElNo. -. .
<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years'? Wes ElNq .
<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) Oyes gNo DDon't know
<br /> 7. Is this to correct a violation? ElYes Rio
<br /> APPLICATION MUST BE SIGNED
<br /> (Continue on Back) -∎ -► -i.
<br /> 545.112 j4roa) -
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